Endoscope equipped with a backhoe

Abstract

The present subject matter provides a spatula attached to a distal edge of an endoscope and configured to protrude from a lower portion of the distal edge, and an endoscope comprising the spatula attached to the distal edge of the endoscope. Additional embodiments of the spatula and the endoscope comprising the spatula are disclosed herein.

Description

Technical Field

[0001] This application claims priority to U.S. Provisional Application No. 63 / 358,181, filed Jul. 4, 2022, the entire content of which is hereby incorporated by reference in its entirety.

[0002] This subject matter relates to endoscopes. More specifically, this subject matter relates to endoscopes equipped with a shovel.

Background Art

[0003] The incision and removal of tissue from a patient's organ, such as tissue suspected to be a tumor, such as a tumor like a polyp, is a procedure known in the art. For the sake of simplicity, the tissue to be treated will hereinafter be referred to as "target tissue". The treatment of target tissue, particularly target tissue that is slightly convex, slightly concave and / or slightly heterogeneous from the surface of the tissue, and more specifically, the treatment of large tissue, is particularly difficult when the target tissue is present in a cavity in the body. For example, in order to incise or cut the target tissue, the target tissue must be raised. Thus, the general treatment, incision or cutting of soft target tissue in particular is difficult, especially when there is a desire to treat the target tissue by less invasive procedures such as endoscopic procedures and polyp incision. Treating the target tissue is also difficult when the target tissue is asymmetric.

[0004] Some types of treatment of the target tissue are difficult, for example, in close imaging of all sides of the target tissue, injection of substances into all sides of the submucosal layer of the target tissue, incision and resection of all sides of the target tissue, such as by polyp incision and / or resection and / or tissue separation, and combinations thereof.

Summary of the Invention

Means for Solving the Problems

[0005] Unless otherwise defined, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this subject matter belongs. Although methods and materials similar or equivalent to those described herein can be used in the practice or testing of this subject matter, suitable methods and materials are described below. In case of conflict, the patent specification, including definitions, will control. In addition, the materials, methods, and examples are illustrative only and not intended to be limiting.

[0006] According to one aspect of the subject matter, a shovel is provided that is attached to the distal edge of an endoscope and configured to protrude from the lower portion of the distal edge.

[0007] According to another aspect of the subject matter, an endoscope is provided that includes a shovel attached to the distal edge of the endoscope.

[0008] According to one embodiment, the shovel has a substantially concave-shaped structure.

[0009] According to one embodiment, the shovel further includes a connector configured to connect the shovel to the distal edge of the endoscope.

[0010] According to one embodiment, the shovel further includes a shovel rail that extends along the width of the shovel and is substantially perpendicular to the length of the endoscope, and the shovel rail is configured to allow a transport means to move along the shovel rail, and thus configured to allow the transport means to move along the width of the shovel.

[0011] According to one embodiment, the endoscope further includes a gripper attached to the distal edge of the endoscope, and the gripper is configured to grip a target tissue in the vicinity of the shovel.

[0012] According to one embodiment, the shovel further includes a shovel cover that covers the shovel from above and is configured to allow a tool to protrude out of the shovel.

[0013] According to one embodiment, the shovel cover has an opening on the front side with respect to the distal edge of the endoscope, and the opening is configured to allow a tool to protrude therethrough.

[0014] According to one embodiment, the shovel cover permanently covers the shovel.

[0015] According to one embodiment, the shovel cover is removable.

[0016] According to one embodiment, a cover connector is attached to the shovel cover and configured to connect the shovel cover to the distal edge of the endoscope.

[0017] According to one embodiment, the cover connector is in the form of a sleeve that engages with the distal edge of the endoscope.

[0018] According to one embodiment, the cover connector is configured to be permanently connected to the distal edge.

[0019] According to one embodiment, the cover connector is configured to be removably connected to the distal edge.

[0020] According to one embodiment, the cover element is at least partially foldable.

[0021] According to one embodiment, the shovel is axially attached to the connector by a horizontal axis located at the bottom of the connector, and the horizontal axis allows the shovel to pivot upward, downward, or both upward and downward.

[0022] According to one embodiment, the shovel is axially attached to the connector by a vertical axis located at the boundary between the shovel and the connector, and the vertical axis allows the shovel to pivot to the right, to the left, or both to the right and to the left.

[0023] According to one embodiment, the shovel further includes a swivel sub-shovel 403 configured to be located above or below the shovel and to swivel laterally, thereby enabling an extension of the width of the shovel.

[0024] According to one embodiment, the shovel further includes a multi-bar cutting tool, the multi-bar cutting tool including a plurality of bars arranged on the shovel.

[0025] According to one embodiment, the shovel further includes a lifting element configured to lift a target tissue, the lifting element being configured to be in a raised state and a lowered state.

[0026] According to one embodiment, the lifting element includes a tissue engagement element configured to engage the target tissue when lifting the target tissue.

[0027] According to one embodiment, the tissue engagement element has a high coefficient of friction that enables a firm engagement of the tissue engagement element with the target tissue and avoids slippage of the target tissue from the tissue engagement element during lifting of the target tissue.

[0028] According to one embodiment, the shovel further includes a suction lifting element configured to engage the target tissue by suction and lift or laterally move the engaged target tissue, the suction lifting element having a nozzle-like structure.

[0029] According to one embodiment, the suction lifting element includes a tissue suction element located at a distal end of the nozzle-like structure of the suction lifting element, the suction lifting element being hollow, the tissue suction element being an opening at the distal end of the suction lifting element, the tissue suction element being configured to engage the target tissue, and then a suction operation in the suction lifting element results in the formation of a vacuum force at the tissue suction element, and the target tissue is held by the suction lifting element.

[0030] According to one embodiment, the suction lifting element further includes at least one protrusion on the upper side of the suction lifting element, or on the bottom side of the suction lifting element, or on both the upper side and the bottom side of the suction lifting element, and the at least one protrusion enables engagement with the target tissue.

[0031] In this specification, embodiments are described by way of example only with reference to the accompanying drawings. Regarding specific detailed references to the drawings, the details shown are for illustrative purposes and are presented for the purpose of an exemplary consideration of the preferred embodiments, and it is emphasized that they are presented to provide what is considered to be the most helpful and easily understood explanation of the principles and conceptual aspects of the embodiments. In this regard, no attempt is made to show structural details in more detail than is necessary for a fundamental understanding, and the description presented with the drawings makes it clear to those skilled in the art how some forms can be embodied in practice.

[0032] The drawings are as follows.

Brief Description of the Drawings

[0033]

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DETAILED DESCRIPTION OF THE INVENTION

[0034] Before describing at least one embodiment in detail, it should be understood that the subject matter is not limited in its application to the details of the configurations described in the following description or shown in the drawings, and the arrangements of components. The subject matter is capable of other embodiments or of being practiced or carried out in various ways. It should also be understood that the syntax and terminology used herein are for the purpose of description and should not be regarded as limiting. In the discussion of the various drawings described below herein, like numerals refer to like parts. Generally, the drawings are not to scale.

[0035] The present subject matter provides a spatula configured to be attached to a distal edge of an endoscope. The present subject matter further provides an endoscope comprising the spatula. The endoscope comprising the spatula is used to treat tissue, preferably target tissue. The endoscope comprising the spatula has several advantages over prior art endoscopes. For example, the spatula stabilizes tools used during treatment of target tissue by the endoscope comprising the spatula. In another example, the spatula enables cutting or injection of, for example, a larger section of target tissue without moving the endoscope laterally as compared to prior art endoscopes. For example, prior art endoscopes can cut or inject a substantially 2-3 mm section of target tissue without moving the endoscope, while an endoscope comprising the spatula can cut or inject a larger section of target tissue, for example, up to or greater than substantially 50 mm, without moving the endoscope. Additionally, the addition of the spatula to the endoscope enables a more stable and controlled treatment, such as incision of target tissue, when the transport means carrying the tool is moving along the rails of the spatula, and prevents uncontrolled, random movement of the transport means and the tool. Additional advantages of the endoscope comprising the spatula are described herein throughout the description of the present subject matter.

[0036] Next, referring to FIG. 1, which schematically shows surface tissue and target tissue according to one exemplary embodiment. FIG. 1 shows an exemplary target tissue 520 extending from surface tissue 510, in other words, a raised tissue 520. The surface tissue 510 is any type of tissue present in a patient's body, for example, surface tissue 510 of an organ or cavity within the body such as the colon, also known as the large intestine, shown in FIG. 1, or any other type of tissue that can be accessed by any tool for surgical activity or any other procedure.

[0037] The target tissue 520 is any type of tissue for which treatment is desired, and this treatment may include, for example, incising the target tissue 520 to separate it from the surface tissue 510, and in some embodiments, removing the incised and separated target tissue 520 from the patient's body, closely imaging all sides of the target tissue 520 from an appropriate angle, injecting substances into all sides of the submucosal layer of the target tissue 520, incising and / or coagulating and / or excising all sides of the target tissue 520 as required by clinical diagnostic methods, and combinations thereof. The use of the term "side" is also intended for all curved portions that form the shape of the target tissue 520.

[0038] Some exemplary target tissues 520 include tumors, tissues suspected of being tumors such as polyps, lesions, and combinations thereof. The target tissue 520 can be symmetric or asymmetric. The target tissue 520 can be hard or soft. The target tissue 520 can be a large, heterogeneous tissue that can be easily treated, for example, incised and separated from the surface tissue 510. Alternatively, the target tissue 520 may protrude slightly from the surface tissue 510, making its treatment more difficult.

[0039] The present subject matter provides a shovel configured to be attached to the distal edge of an endoscope. The present subject matter further provides an endoscope comprising the shovel. The endoscope comprising the shovel is used for the treatment of tissue, preferably the target tissue 520.

[0040] According to one embodiment, the endoscope comprising the shovel is configured to enable access to various tools to the tissue, particularly the target tissue 520. Some exemplary tools include an incision tool, a coagulation tool, an excision tool, a grasping tool, an imaging tool, an injection tool, and the like.

[0041] In some embodiments, an endoscope comprising the shovel of the present subject matter enables incision of a target tissue 520 in a patient's body and separation from the surface tissue 510. In some other embodiments, an endoscope comprising the shovel of the present subject matter further enables removal of the incised and separated target tissue 520 from the patient's body. In some additional embodiments, an endoscope comprising the shovel of the present subject matter enables performance of additional procedures on the target tissue 520 and its surroundings.

[0042] According to one embodiment, the shovel facilitates incision of the target tissue 520. When the target tissue 520 is incised, the shovel can enter into the incision of the incised target tissue 520. This enables stabilization of the target tissue 520 during the incision and allows the operator of the endoscope comprising the shovel to view the line of the incision and better control the incision process.

[0043] According to one embodiment, the shovel enables stretching of the surface tissue 510 near the base portion of the target tissue 520. This embodiment allows the operator of the endoscope comprising the shovel to treat the target tissue 520 with improved stability and accuracy.

[0044] According to one embodiment, the shovel is configured to prevent a tool carried by the endoscope comprising the shovel from descending below the level of the shovel. This embodiment prevents damage to the healthy surface tissue 510 under the target tissue 520 by the tool.

[0045] According to one embodiment, the shovel is configured to enable measurement at any location where the target tissue and the shovel are adjacent. This is because the shovel can be used as a reference for length during imaging when the endoscope comprising the shovel is in use.

[0046] According to one embodiment, the patient is an animal, particularly a vertebrate. According to another embodiment, the patient is a human.

[0047] As disclosed herein, the term "tool" refers to any type of tool configured to be used during the treatment of tissue in a patient's body. Some exemplary types of tools include cutting tools configured to incise tissue, grasping tools configured to grasp tissue pieces, containment tools configured to contain an object, such as a tissue piece, during removal of the object from the patient's body, imaging tools configured to acquire images inside the patient's body, illumination tools configured to illuminate the inside of the patient's body, injection tools configured to inject substances into tissue, cautery tools configured to cauterize a portion of tissue, and any combination thereof.

[0048] Next, referring to FIG. 2, which schematically shows a perspective view of a prior art endoscope approaching a target tissue according to one exemplary embodiment. FIG. 2 shows an internal cavity having a surface tissue 510 and a target tissue 520 extending over the surface tissue 510. A prior art endoscope 60 inserted into the cavity includes a distal edge 62. The distal edge 62 is the edge of the endoscope 60 inserted into the patient's body, and at least one channel, such as channel 601 and channel 602, opens, enabling a tool conveyed through at least one channel to exit. For example, FIG. 2 illustrates a cutting tool 300 exiting channel 601.

[0049] Next, referring to FIG. 3A, which schematically shows a distal edge of an endoscope with a shovel and a first mechanism for facilitating movement of a transport means along the width of the shovel according to some exemplary embodiments. FIG. 3A illustrates the distal edge 62 of the endoscope 60. According to one embodiment, the endoscope 60 includes a shovel 402 connected to or configured to connect to the distal edge 62 of the endoscope 60. The shovel 402 has a substantially concave structure and projects from the lower part of the distal edge 62. In other words, when the endoscope 60 moves over the surface tissue 510, the shovel 402 is configured to at least occasionally contact the surface tissue 510.

[0050] According to one embodiment, the bottom surface of the spatula 402 is configured to slide on the surface tissue 510, for example, during the movement of the endoscope inside the cavity 550. This embodiment is advantageous over the prior art endoscope 60 that does not include the spatula 402 and thus may face difficulties during movement in the cavity 550.

[0051] Additional advantages of the spatula 402 will be described throughout the remainder of this description with respect to the treatment of the target tissue 520. Briefly, according to one embodiment, the spatula 402 is configured to flatten the folds on the surface tissue 510 during the movement of the endoscope 60, and thus facilitate the smooth movement of the endoscope 60 with the spatula 402 inside the cavity 550. According to another embodiment, the spatula 402 is configured to push the target tissue 520, for example, during the treatment of the target tissue 520. According to yet another embodiment, the spatula 402 is configured to protect the surface tissue 510 and the target tissue 520 from possible losses that may occur during the treatment of the target tissue 520. For example, the spatula 402 can prevent the cutting tool 300 from being deeply inserted into the target tissue 520, or the cutting tool 300 from penetrating at too low an angle into the target tissue 520 such that there is a risk of damaging an area of tissue that is not in the relevant area. In other words, the spatula 402 can prevent or limit the undesired movement of the endoscope 60 with the spatula 402 or the undesired movement of tools such as the cutting tool 300 when treating the target tissue 520.

[0052] According to one embodiment, the spatula 402 is an integral part of the endoscope 60. According to this embodiment, the endoscope 60 is manufactured together with the spatula 402 at the distal edge 62 of the endoscope 60. According to another embodiment, the spatula 402 is configured to be connected to the distal edge 62 of the endoscope 60. According to this embodiment, the spatula 402 includes a connector 404 configured to connect the spatula 402 to the distal edge 62. Any mechanism of the connector 404 for connecting to the distal edge 62 of the endoscope 60 is within the scope of the present subject matter. The exemplary connector 404 illustrated in FIG. 3A has a cylindrical structure, is mounted on the distal edge 62, and is configured to grip the distal edge 62 of the endoscope 601. This embodiment enables the installation of the spatula 402 on an existing endoscope 60.

[0053] According to one embodiment, the spatula 402 includes a mechanism that facilitates the movement of the transport means 120 along the width of the spatula 402. This embodiment is advantageous over prior art endoscope - carried tools as it enables access to a wider area of the target tissue 520, for example the cutting tool 300, compared to tools carried by prior art endoscopes 60. A first such mechanism is illustrated in FIG. 3A. Thus, according to one embodiment, the spatula 402 includes a spatula rail 113 that extends along the width of the spatula 402. According to another embodiment, the spatula rail 113 is substantially perpendicular to the length of the endoscope 60. The spatula rail 113 is configured to allow the transport means 120 to move along the spatula rail 113, and thus to move along the width of the spatula 402. The transport means 120 illustrated in FIG. 3A projects out from the channel 601 of the endoscope 60 and engages with the spatula rail 113. Arrow 902 indicates the direction in which the transport means 120 can move along the spatula rail 113, which is a lateral direction along the spatula rail 113, a direction along the width of the spatula 402, and a direction perpendicular to the length of the endoscope 60.

[0054] According to one embodiment, a tool, for example, a cutting tool 300, is attached to a transport means 120. Thus, according to the embodiment illustrated in FIG. 3A, an endoscope 60 having a spatula 402 inserts the endoscope 60 having the spatula 402 and a spatula rail 113 near the target tissue 520; inserts the transport means 120 carrying the cutting tool 300 through the endoscope 60; engages the transport means 120 with the spatula rail 113 and approaches the spatula 402 to the base portion of the target tissue 520; moves the transport means 120 back and forth along the spatula rail 113 as indicated by the arrow 902 in FIG. 3A while operating the cutting tool 300; and when the target tissue 520 is incised by the cutting tool 300, further pushes the endoscope 60 having the spatula 402 toward the target tissue 520 to enable further incision of the target tissue 520 by the cutting tool 300, thereby being configured to incise the target tissue 520.

[0055] Next, referring to FIG. 3B, which schematically shows the distal edge of an endoscope with a shovel and a second mechanism for facilitating movement of a transport means along the width of the shovel, according to some exemplary embodiments. FIG. 3B illustrates a shovel 402 with a second mechanism for facilitating movement of a transport means along the width of the shovel, similar to the shovel 402 illustrated in FIG. 3A. According to one embodiment, the second mechanism includes a screw 124 positioned along the width of the shovel 402, for example, near the distal edge of the shovel 402, a bolt 126 attached to the transport means 120 and screwed onto the screw 124, and a motor 122 positioned fairly close to the side of the shovel 402. The screw 124 is attached to the motor 122, and the motor 122 is configured to rotate the screw 124. Since the motor 122 and the screw 124 are fixed in place and the transport means 120 to which the bolt 126 is attached is movable, rotation of the screw 124 by the motor 122 results in movement of the bolt 126 along the screw 124, and thus movement of the transport means 120 along the screw 124. Since the screw 124 is positioned along the width of the shovel 402, rotation of the screw 124 results in movement of the transport means 120 along the width of the shovel 402. Rotation of the screw 124 in a first direction, for example, clockwise, moves the bolt 126 and the transport means 120, for example, toward the motor 122, while rotation of the screw 124 in a second direction, for example, counterclockwise, moves the bolt 126 and the transport means 120, for example, away from the motor 122.

[0056] Next, referring to FIGS. 4A-4B, which schematically show views of the distal edge of an endoscope equipped with a shovel and a third mechanism for facilitating movement of a transport means along the width of the shovel from two different angles. In the third mechanism, according to one embodiment, the transport means 120 further includes a wheel motor 127 attached to the transport means 120 and a drive wheel 125 attached to the wheel motor 127 and configured to be rotated by the wheel motor 127 to drive the transport means 120 during rotation. In other words, the drive motor 127 is configured to rotate the drive wheel 125 in a clockwise or counterclockwise direction. Additionally, the shovel 402 corresponds to the drive wheel 125 of the transport means 120 and further includes a wheel rail 115 that extends along the width of the shovel 402. Accordingly, the drive wheel 125 is configured to move along the wheel rail 115 corresponding to the direction of rotation of the drive wheel 125. According to another embodiment, the drive wheel 125 has teeth and the wheel rail 115 also has teeth. This embodiment allows for a strong coupling of the drive wheel 125 with the wheel rail 115 and prevents the drive wheel 125 from slipping from the wheel rail 115. It should be noted that the embodiment of the drive wheel 125 having teeth and the corresponding wheel rail 115 having teeth is merely illustrative and should not be considered as limiting the scope of the present subject matter. Any type, structure, and mechanism of the coupling of the drive wheel 125 with the wheel rail 115 are within the scope of the present subject matter.

[0057] The cutting tool 300 attached to the transport means 120 can also be seen in FIGS. 4A - 4B. The shovel rail 113 shown in FIG. 3A also exists in the shovel 402 shown in FIGS. 4A - 4B and is configured to support the cutting tool 300 while the cutting tool 300 is being moved together with the transport means 120. This is achieved, according to one embodiment, by a protrusion 129 protruding from the transport means 120 or from the cutting tool 300 towards the shovel rail 113. According to another embodiment, the protrusion 129 is configured to engage with the shovel rail 113 and slide along the shovel rail 113. This embodiment stabilizes the tool 300 during the movement of the transport means 120 along the width of the shovel 402.

[0058] Still referring to FIGS. 4A - 4B, according to one embodiment, the shovel rail 113 has a low coefficient of friction. In other words, the shovel rail 113 is smooth and thus allows the sliding of the transport means 120, or the tool, or the protrusion 129 along the shovel rail. Any mechanism that makes the shovel rail 113 have a low coefficient of friction or be smooth is within the scope of the present subject matter. For example, the surface of the shovel rail 113 is made of a material having a low coefficient of friction. The advantage of this embodiment is that the smooth shovel rail 113 allows for the rapid sliding of the transport means 120, or the tool, or the protrusion 129 along the shovel rail 113 without requiring much energy expenditure for the movement of the transport means 120 or the tool.

[0059] According to another embodiment, the shovel rail 113 has a high coefficient of friction. In other words, the shovel rail 113 is rough, and thus stabilizes the transport means 120, or the tool, or the protrusion 129 during movement along the shovel rail 113. Any mechanism for making the shovel rail 113 have a high coefficient of friction or be rough is within the scope of the present subject matter. For example, the surface of the shovel rail 113 is made of a material having a high coefficient of friction. In another example, the surface of the shovel rail 113 includes protrusions, or bumps, or teeth that prevent the smooth sliding of the transport means 120, or the tool, or the protrusion 129 along the shovel rail 113. The advantage of this embodiment is that the rough shovel rail 113 stabilizes the transport means 120, or the tool during its movement along the shovel rail 113.

[0060] Another embodiment illustrated in FIGS. 4A - 4B relates to the transmission of power through the endoscope 60 to the transport means 120 and the tool, such as the cutting tool 300, and the transmission of data to and from the tool or the imaging device and the like. According to one embodiment, the transmission of power through the endoscope 60 to components functioning on or in the vicinity of the shovel 402 is effected by at least one cable 652, such as the electrical cable 652. According to another embodiment, the transmission of data to or from, or to and from components functioning on or in the vicinity of the shovel 402 is effected by at least one cable 652, such as the data transmission cable 652. According to yet another embodiment, as seen in FIGS. 4A - 4B, a plurality of cables 652 are bundled as the cable blade 65.

[0061] Next, referring to FIG. 5, which schematically shows two positions of an endoscope with a shovel for incising a target tissue, according to one exemplary embodiment. FIG. 5 illustrates an endoscope 60 with a shovel 402 at a first position 60-I in the vicinity of the target tissue 520. At this position, a cutting tool 300 carried by a transport means 120 protruding from the endoscope 60 cuts a first incision 522-I at the base of the target tissue 520. Since the endoscope 60 is equipped with the shovel 402, the transport means 120 moves laterally along the width of the shovel 402, for example, in one of the mechanisms already described and illustrated in FIGS. 3A-3B and FIGS. 4A-4B. As a result, the first incision 522-I at the base of the target tissue 520 has a length indicated by the line 522-I. The length of the first incision 522-I is greater than the incision made by a prior art endoscope 60 lacking the shovel 402, because the movement of the transport means 120 carried by the prior art endoscope 60 is more limited compared to the transport means 120 carried by the endoscope 60 equipped with the shovel 402. This embodiment shows one of the advantages of the endoscope 60 with the shovel 402 of the present subject matter compared to a prior art endoscope 60 lacking the shovel 402.

[0062] After the first incision 522-I is made, the endoscope 60 moves laterally to a second position 60-II, and the cutting tool 300 makes a second incision 522-II at the base of the target tissue 520. The second incision is continuous with the first incision 522-II. In this way, finally, the entire target tissue 520 can be cut and the target tissue 520 can be removed.

[0063] FIG. 5 illustrates a virtual boundary 523 between a first incision 522-I and a second incision 522-II. The boundary 523 indicates a location on the target tissue 520 where the first incision 522-I ends and the second incision 522-II begins. In this embodiment, the second incision 522-II begins at the location where the first incision 522-I begins. Thus, the length of the second incision 522-II can be substantially equal to the length of the first incision 522-I. This can be achieved, for example, by making the incision 522-I when the endoscope 60 is in the first position 60-I. The endoscope 60 is then moved to the second position 60-II and the cutting of the second incision 522-II is started at a point where the first incision 522-I has substantially ended.

[0064] However, according to another embodiment, there may be an overlap between the first incision 522-I and the second incision 522-II. This can be achieved, for example, by making the incision 522-I when the endoscope 60 is in the first position 60-I. The endoscope 60 is then moved to the second position 60-II and the cutting of the second incision 522-II is started at a point within the first incision 522-I.

[0065] It should be noted that the embodiment illustrated in FIG. 5 is only by way of example and relates to any treatment of the target tissue 520 that requires movement of the tool along the width of the shovel 402, for example, injection of a substance into the target tissue, imaging of a specific location of the target tissue 520, etc.

[0066] Next, referring to FIGS. 6A-6B which schematically show perspective views of a grasping tool in a retracted state and an extended state, respectively, attached to an endoscope equipped with a shovel. FIGS. 6A-6B illustrate an endoscope 60 that includes a shovel 402 and additionally includes a grasping tool 702. Thus, according to one embodiment, an endoscope 60 equipped with a shovel 402 further includes a grasping tool 702 attached to the distal edge 62 of the endoscope 60. The grasping tool 702 is configured to grasp a target tissue 520 near the distal edge 62 of the endoscope 60, or more specifically, near the shovel 402 of the endoscope 60. According to another embodiment, the grasping tool 702 is attached to the distal edge 62 by an arm 704. According to yet another embodiment, as illustrated in FIG. 5B, the arm 702 is fixed and extends to form a distance 750 between the grasping tool 702 and the distal edge 62 of the endoscope 60, or between the grasping tool 702 and the shovel 402 attached to the distal edge 62 of the endoscope 60. The grasping tool 702 can have any size and shape that allows the grasping tool 702 to grasp the target tissue 502. When the grasping tool 702 is used, the target tissue 502 is grasped between the grasping tool 702 with the intervening distance 750 and the distal edge 62 or the shovel 402.

[0067] According to a further embodiment, the arm 704 is extendable. Thus, the arm 704 can be in two states, namely a retracted state and an extended state. The retracted state of the arm 704 is illustrated in FIG. 6A. For example, the retracted state of the arm 704 is used when the endoscope 60 is transported through the patient's body to a target location, e.g., the target tissue 520 to be treated. In the retracted state of the arm 702 illustrated in FIG. 6A, the grasping tool 704 is close to the distal edge 62 of the endoscope 60, or to the shovel 402 attached to the distal edge 62 of the endoscope 60.

[0068] The arm portion 704 in the extended state is illustrated in FIG. 6B. For example, the arm portion 702 is extended when it is necessary to grip the target tissue 520, for example, during cutting of the target tissue 520. Arrow 904 indicates the movable direction of the extendable arm portion 704 and the gripper 702 attached to the extendable arm portion 704, that is, the extendable arm portion 704 and the gripper 702 attached to the extendable arm portion 704 move in a direction continuous with the length of the endoscope 60, a direction away from the distal edge 62 of the endoscope 60, a direction away from the shovel 402, a direction toward the distal edge 62 of the endoscope, or a direction toward the shovel 402.

[0069] Next, referring to FIG. 7, which schematically shows another structural embodiment of the gripper and the arm portion according to one exemplary embodiment. The gripper 702 and the arm portion 704 illustrated in FIG. 7 are similar in function to the embodiments described in connection with FIGS. 6A - 6B. However, the gripper 702 and the arm portion 704 illustrated in FIG. 7 are different in structure in that the gripper 702 and the arm portion 704 are made of one part, for example, a bent wire. The extension of the wire forms the arm portion 704, and the bent portion of the wire forms the gripper 702.

[0070] According to another embodiment, the arm portion 704 is configured to be attached to the endoscope 60. According to yet another embodiment, the arm portion 704 further includes an arm connector 706 configured to connect the arm portion 704 to the endoscope 60. Any type of arm connector 706 is within the scope of the present subject matter. An exemplary embodiment of the arm connector 706 is illustrated in FIG. 7. According to this embodiment, the arm connector 706 is attached to the arm portion 704 and is configured to surround the endoscope 60 so as to connect the arm portion 704 to the endoscope 60. According to one exemplary embodiment, the arm connector 706 has a sleeve structure configured to surround the endoscope 60 and to impart axial movement to the arm of the gripper 702 outward from the scope distal tip transport position and duck on the distal side of the raised target tissue. According to another embodiment, the arm connector 706 has a coil structure configured to surround the endoscope 60 as seen in FIG. 7A. According to yet another embodiment, the connector 706 has a flexible stent-tube structure.

[0071] According to one embodiment, the arm connector 706 has shape memory that tends to pull the arm 704 and the gripper 702 toward the endoscope 60. According to another embodiment, the arm 704 and the gripper are configured to be pushed away from the endoscope 60 by an operator of the endoscope 60. Any mechanism, such as by manually pushing with a cable or by at least one motor, can be used to push the arm 704 and the gripper 702 away from the endoscope 60. These embodiments enable the target tissue 520 to be easily grasped by the gripper 702. For example, when the endoscope 60 reaches the target tissue 520, the arm 704 and the gripper 702 are pushed away from the endoscope 60 so as to move the gripper 702 to the rear side of the target tissue 520 relative to the endoscope 60, while the target tissue 520 is positioned between the shovel 402 and the gripper and the arm 704 is positioned above the target tissue 520. Then, the pushing of the arm 704 and the gripper 702 is released, and as a result, the arm 704 and the gripper move toward the endoscope 60 due to the shape memory of the arm connector 706 described above. This results in the grasping of the target tissue 520 by the gripper 702 and, when such a bulge of the target tissue 520 is desired, such a bulge of the target tissue 520 by the gripper 702.

[0072] Next, referring to FIG. 8, which schematically shows an endoscope including a shovel, a gripper, an arm, and further including a rear imaging device. According to the embodiment illustrated in FIG. 8, an endoscope 60 including a shovel 402, a gripper 702, and an arm 704 further includes a rear imaging device 720 configured to acquire an image from the opposite side of a target tissue 520 grasped by the gripper 702. The rear imaging device 720 is located near the gripper 702 and is connected to the arm connector 706 or is directly connected to the endoscope 60 by the imaging device arm 722. According to one embodiment, the imaging device arm 722 is configured to connect the rear imaging device 720 to the endoscope 60. According to another embodiment, the imaging device arm 722 is configured to connect the rear imaging device 720 to the arm connector 706. However, according to yet another embodiment, the rear imaging device 720 is attached to the gripper 702. According to a further embodiment, the imaging device arm 722 includes a wire configured to transmit a signal through the endoscope to an input device located outside the patient's body, and the input device is configured to acquire a signal from the rear imaging device 720 and process the signal. However, according to an additional embodiment, the rear imaging device 720 is wirelessly connected to the input device, and thus the imaging device arm 722 need not include a wire.

[0073] According to one embodiment, the rear imaging device 720 is configured to be moved by an operator of the endoscope 60. Any type of movement of the rear imaging device 720 and any type of mechanism for moving the rear imaging device 720 and controlling the movement of the rear imaging device 720 are within the scope of the present subject matter. For example, the rear imaging device 720 is configured to pivot laterally or, for example, upwardly and downwardly. The movement of the rear imaging device 720 can be achieved mechanically, for example, by using a cable or by at least one motor.

[0074] Next, referring to FIG. 9, which schematically shows the field of view of the rear imaging device according to one exemplary embodiment. The endoscope 60 comprising the shovel 402, the gripper 702, the arm 704, the rear imaging device 702, and the imaging device arm 722, as illustrated in FIG. 9, is essentially similar to that illustrated in FIG. 8. FIG. 9 additionally illustrates the field of view 725 of the rear imaging device 720. The field of view 725 has a three-dimensional funnel-shaped form extending from the rear imaging device 720. Any object within the field of view 725 is imaged by the rear imaging device 720. According to the embodiments illustrated in FIGS. 8 and 9, the rear imaging device 720 is oriented towards the endoscope 60. Thus, it is located between the rear imaging device 720 and the endoscope 60, or more specifically, between the rear imaging device 702 and the shovel 702, and any object within the field of view 725 of the rear imaging device 720 can be imaged. The advantages of this embodiment are shown in FIG. 10 below.

[0075] Next, referring to FIG. 10, which schematically shows a side view of an endoscope with a shovel for imaging a rear view of target tissue grasped by a gripper inside a cavity according to one exemplary embodiment. As can be seen in FIG. 10, the endoscope 60 comprising the shovel 402 is inserted into a cavity 550 in the patient's body, for example, into the intestine, to image the target tissue 520 from a rear view. The endoscope 60 further comprises a gripper 702 and a rear imaging device 720, as illustrated in FIGS. 8 - 9. The prior art endoscope 60 comprises a prior art imaging device attached to the front side of the endoscope 60 and configured to image the front view of the endoscope 60. Thus, if the prior art endoscope 60 were used in the scenario illustrated in FIG. 10, the prior art imaging device of the prior art endoscope 60 would image only a part of the target tissue 520 facing the endoscope 60. By using the prior art imaging device of the prior art endoscope 60, it is impossible to image the side portion of the target tissue 520 on the side opposite to the endoscope 60, because that is hidden from the prior art imaging device of the prior art endoscope 60.

[0076] However, as can be seen in FIG. 10, the rear imaging device 720 faces towards the endoscope 60, and when the rear imaging device 720 is positioned in front of the rear side portion of the target tissue 520 as can be seen in FIG. 10, the rear side portion of the target tissue 520 is within the field of view 725 of the rear imaging device 720, and thus, imaging of the rear side portion of the target tissue 520 is enabled.

[0077] According to one embodiment, in the scenario illustrated in FIG. 10, the grasping tool 702 can be used to grasp the target tissue 520 on the opposite side of the target tissue 520, and further, can also be used to elevate the target tissue 520, and thus, facilitate imaging on the opposite side of the target tissue 520.

[0078] Another advantageous feature of the spatula 402 illustrated in FIG. 10 relates to the depth of the incision 522 made in the target tissue 520. When using a prior art endoscope 60, the depth of the incision 522 is limited by the length of the protrusion of the cutting tool 300. This is because the width of the endoscope 60 is large and the endoscope cannot penetrate into the incision 522 made in the target tissue 500. However, the height of the spatula 402 is smaller than the height of the endoscope 60, and thus, enables penetration of the spatula 402 into the incision 522, thereby increasing the depth of the incision 522 in the target tissue 520. As can be seen in FIG. 10, the spatula 402 penetrates into the incision 522, and as a result, the portion 520-U of the target tissue 520 rides on the spatula 402. This situation may interfere with the function of the endoscope 60, for example, masking the field of view of the imaging device of the endoscope 60, or exposing components of the spatula 402 such as the transport means 120 and the tool and bringing them into direct contact with the tissue and moisture. A solution for this situation will be described hereinafter, for example, in FIGS. 12 to 13.

[0079] Next, referring to FIG. 11, which schematically shows a side view of an endoscope comprising a shovel and a gripper and incising a target tissue grasped by the gripper. As can be seen in FIG. 11, an endoscope 60 comprising a shovel 402 is inserted into a cavity 550 in a patient's body, for example, into the intestine, to cut the target tissue 520. The endoscope 60 further comprises a gripper 702 similar to the gripper 702 already shown. According to the embodiment described above, the cutting tool 300 is located on the shovel 402. When the cutting tool 300 incises the target tissue 520, the gripper 702 grips the target tissue 520 on the side opposite to the cutting tool 300. This is achieved by an arm 704 that holds the gripper 702 at a distance from the shovel 702. Thus, the gripper 702 stabilizes the target tissue 520 and enables easier and more accurate incising of the target tissue 520. As a result, the incision 522 in the target tissue 520 can be made with high accuracy with respect to the position of the incision 522 in the target tissue 520, as well as the width and length of the incision 522. This is another advantage of using the gripper 702 in combination with the shovel 402, because when the target tissue 520 is incised by a conventional endoscope 60 comprising a cutting tool 300, the target tissue 522 is neither grasped nor stabilized, and since the target tissue 520 is soft by nature, there are limitations to the accuracy of the position, width and length of the incision 522.

[0080] Next, referring to FIG. 12, which schematically shows an endoscope including a shovel and a shovel cover according to one exemplary embodiment. However, before describing various embodiments of the shovel cover 80, FIG. 12 shows an embodiment of a second mechanism that facilitates the movement of the transport means 120 along the width of the shovel 402 illustrated in FIG. 3B. FIG. 12 illustrates a screw 124 located along the width of the shovel 402. However, FIG. 12 does not illustrate a bolt 126 attached to the transport means 120 and screwed onto the screw 124, nor a motor 122 located fairly close to the side of the shovel 402. As detailed in the description of FIG. 3B above, the screw 124 is attached to the motor 122, and the motor 122 is configured to rotate the screw 124.

[0081] According to one embodiment illustrated in FIG. 12, an endoscope 60 including a shovel 402 further includes a shovel cover 80 configured to cover the shovel 402 from above and to allow a tool 300 to protrude outward from the shovel 402. As seen in FIG. 12, the shovel cover 80 covers the shovel 402, the transport means 120, and a tool in the form of a cutting tool 300 on the shovel 402. In addition, the shovel cover 80 includes an opening 805 on the front side with respect to the distal edge 62 of the endoscope. The opening 805 is configured to allow the tool to protrude from the shovel 402. Thus, the cutting tool 300 illustrated in FIG. 12 can incise the target tissue 250 by protruding through the opening 805 of the shovel cover 80.

[0082] Another embodiment of the shovel cover 80 is that the shovel cover is configured to protect the shovel 402 and components on the shovel 402, such as the transport means 120 and the tool, from physical damage that may occur during the insertion of the endoscope 60 into the patient's body, and from moisture that may damage components such as blood and mucus.

[0083] According to yet another embodiment, the shovel cover 80 is substantially transparent. Thus, as illustrated in FIG. 12, the transport means 120 is partially visible through the shovel cover 80. This embodiment of the transparent shovel cover 80 enables imaging by a prior art imaging device located, for example, laterally to the transport means 120 at the distal edge of the endoscope 60. Thus, it is not necessary to remove or open the shovel cover 80 or to project the imaging device through the opening 805 of the shovel cover 80 in order to acquire an image by a prior art imaging device of the endoscope 60.

[0084] Any mechanism for attaching the shovel cover 80 onto the shovel 402 is within the scope of the present subject matter. According to one embodiment, the shovel cover 80 permanently covers the shovel 402. According to another embodiment, the shovel cover 80 is removable. According to the exemplary embodiment illustrated in FIG. 12, a cover connector 807 is attached to the shovel cover 80 and configured to connect the shovel cover 80 to the endoscope 60 or to the distal edge 62 of the endoscope 60. For example, the cover connector 807 is in the form of a sleeve that engages the distal edge 62 of the endoscope 60 and connects permanently or removably to the distal edge 62.

[0085] Any size and shape of the shovel cover 80 is within the scope of the present subject matter. For example, the shovel cover 80 illustrated in FIG. 12 is inclined from the distal edge 62 towards the opening 805 and has a concave shape. This exemplary embodiment of the shape of the shovel cover 80 allows moisture and dust to slide off the shovel cover 80 and enables, for example, viewing through the transparent shovel cover 80 by a prior art imaging device from the endoscope 60 despite the accumulation of moisture and dust on the shovel cover 80, since this moisture and dust slides off the shovel cover 80. Additional embodiments of the size and shape of the shovel cover 80 are illustrated in FIGS. 13A - 13C.

[0086] Next, referring to FIGS. 13A-13C, which schematically illustrate various examples of the size and shape of the shovel cover according to one exemplary embodiment. All of the shovel covers 80 illustrated in FIGS. 13A-13C include a cover connector 807. Since the cover connector 807 is configured to engage with the distal edge 62 of the endoscope 60 or the endoscope 60, the size and shape of the shovel connector 807 are substantially similar in all types of shovel covers 80 illustrated in FIGS. 13A-13C. However, it should be noted that the shape and size of the cover connector 807 can be different, for example, to fit the size and shape of various types of endoscopes 60 or the distal edge 62 of the endoscope 60.

[0087] According to another example illustrated in FIGS. 13A-13C, the shovel cover also includes a cover element 809. Thus, according to this embodiment, the shovel cover 80 includes a cover element 809 configured to cover the shovel 402 and a cover connector 807 attached to the cover element 809 and configured to connect the shovel 80 to the endoscope 60 or the distal edge 62 of the endoscope 60. According to the embodiment described above, the cover element 809 is substantially transparent, and according to another embodiment, the cover element 809 is opaque, in other words, not transparent.

[0088] Any size and shape of the cover element 809 are within the scope of the present subject matter. It should be noted that the types of cover elements 809 illustrated in FIGS. 13A - 13C are merely exemplary and should not be considered as limiting the scope of the present subject matter. For example, according to one embodiment illustrated in FIG. 13A, the cover element is substantially cylindrical and has a diameter substantially similar to the diameter of the endoscope 60. According to another embodiment illustrated in FIG. 13B, the cover element 809 is substantially inclined and has a height similar to the height of the endoscope 60 at the edge adjacent to the endoscope 60 and a lower height than the height of the endoscope 60 at the edge in the distal direction from the endoscope 60. In a further embodiment illustrated in FIG. 13C, the cover element 809 is substantially rectangular. In yet a further embodiment, the height of the rectangular cover element 809 is lower than the height of the endoscope 60.

[0089] Another embodiment similar to all the shovel - covers 80 illustrated in FIGS. 13A - 13C is that the shovel - cover 80 comprises an opening 805 at the edge in the distal direction from the endoscope 60. As described above, the opening 805 is configured to allow the protrusion of a tool from the shovel 402, for example, as illustrated in FIG. 12. According to another embodiment, the opening 805 allows imaging by a prior - art imaging device of the endoscope 60. The opening 8 can have any size and shape. For example, the shovel - cover 13A illustrated in FIG. 13A has a semi - cylindrical shape and comprises a large opening 805 having a diameter substantially similar to the diameter of the endoscope 60. In contrast, the shovels 80 illustrated in FIGS. 13B - 13C have a rectangular shape and comprise a smaller opening 805 having a height smaller than the height of the endoscope 60. The size and shape of the opening 805 can be adapted, for example, to the type, size, and shape of the tool used.

[0090] Next, referring to FIG. 14A, which schematically shows a side perspective view of a foldable shovel cover in an extended state according to one exemplary embodiment. According to one embodiment, the cover element 809 of the shovel cover 80 is at least partially foldable. According to this embodiment illustrated in FIG. 14A, the cover element 809 of the shovel cover 80 includes a first cover 8092 and a second cover 8094. The first cover 8092 is extended between a first frame 801 and a second frame 802, and the second cover 8094 is extended between the second frame 802 and a cover connector 807. According to one embodiment, the first frame 801 and the second frame 802 are axially attached to the shovel 402 by a cover shaft 803. The cover shaft 803 can be installed at any position on the shovel 402. According to one embodiment illustrated in FIG. 14A, the cover shaft 803 is installed at the distal edge of the shovel 402. According to one embodiment, the first frame 801 is configured to pivot about the cover shaft 803. According to another embodiment, the second frame 802 is configured to pivot about the cover shaft 803. According to yet another embodiment, the first frame 801 and the second frame 802 are configured to pivot about the cover shaft 803.

[0091] Next, referring to FIGS. 14B - 14C, which respectively schematically show side views of a foldable shovel cover in an extended state and a folded state according to one exemplary embodiment. In FIG. 14B, the foldable shovel cover 80 is in an extended state similar to the foldable shovel cover illustrated in FIG. 14A. The first frame 801 is pivoted forward away from the endoscope 62, whereby the first cover 8092 covers the front portion of the shovel 402. In this state, the second frame is positioned substantially perpendicular to the shovel 402, and the second cover 8094 covers the central and rear portions of the shovel 402.

[0092] According to one embodiment, as illustrated in FIGS. 14A - 14B, the foldable shovel cover 80 in the expanded state is configured to enable smooth and easy movement of the endoscope inside the cavity 550. This is achieved, for example, by the shape of the foldable shovel cover 80 as seen in FIG. 14B, particularly the shape of the first cover 8092 and the second cover 8094. According to another embodiment, the foldable shovel cover 80 in the expanded state has a bent shape similar to a hydrodynamic shape, which enables smooth movement of the endoscope 60 on the front side through the tissue and, in particular, the cavity 550.

[0093] In FIG. 14C, which illustrates the foldable shovel cover 80 in the folded state, both the first frame 801 and the second frame 802 are pivoted backward towards the endoscope 60. As a result, the first cover 8092 covers the central part of the shovel 402, the second cover 8094 covers the rear side part of the shovel, while the front part of the shovel 402 is not covered.

[0094] FIGS. 14B - 14C additionally illustrate a frame arm 870 that is operated by the operator of the endoscope 60 and is configured to push the first frame 801 forward or backward as desired. According to one embodiment, one end of the frame arm 870 is attached to the first frame 801, and the other side of the frame arm 870 is connected to a control panel or handle that is operated by the operator of the endoscope 60, either directly, or by a wire, or wirelessly. Pushing the frame handle 870 forward moves the first frame 801 forward, and pulling the frame handle 870 backward moves the first frame backward.

[0095] The examples of the frame arm 870 connected to the first arm 801 illustrated in FIGS. 14B to 14C are merely illustrative and should not be considered as limiting the scope of the present application. According to another example, the frame arm 870 is connected to the second frame 8094 and configured to push the second frame 802 forward or pull it backward.

[0096] According to one example, the first cover 8092 is made of a foldable material, such as a foldable sheet of nylon or fabric. According to another example, the first cover 8092 is rigid.

[0097] According to one example, the second cover 8094 is made of a foldable material, such as a foldable sheet of nylon or fabric. According to another example, the second cover 8094 is rigid.

[0098] According to an example of the first cover 8092 made of a foldable material, as illustrated in FIGS. 14A to 14B, as the first frame 801 pivots away from the endoscope 60, the first cover 8092 is unfolded. According to an example of the first cover 8092 made of a rigid material, as illustrated in FIGS. 14A to 14B, as the first frame 801 pivots away from the endoscope 60, the first cover 8092 is pulled out.

[0099] According to an example of the second cover 8094 made of a foldable material, as illustrated in FIGS. 14A to 14B, as the second frame 802 pivots away from the endoscope, the second cover 8094 is unfolded. According to an example of the second cover 8094 made of a rigid material, as illustrated in FIGS. 14A to 14B, as the second frame 802 pivots away from the endoscope, the second cover 8094 is pulled out.

[0100] According to one embodiment, in the deployed state illustrated in FIG. 14C, according to an embodiment of the second cover 8094 made of a foldable material, as the second frame 802 pivots towards the endoscope 60, the second cover 8094 is folded or collapsed. According to an embodiment, as the second frame 802 pivots towards the endoscope 60, the second cover 8094 is pushed inside the endoscope or under the cover connector 807.

[0101] Next, referring to FIG. 14D, which schematically shows a side view of a foldable shovel cover according to one exemplary embodiment. According to the embodiment illustrated in FIG. 14D, the shovel cover 80 includes a cover frame 806 axially attached to the shovel 402 by a cover shaft 803 and a foldable cover 8096. One side of the foldable cover 8096 is attached to the cover frame 806 and the other side of the foldable cover 8096 is attached to the cover connector 807. As shown in FIG. 4D, when the cover frame 806 pivots towards the endoscope 60, the foldable cover 8096 is folded and the shovel 402 is uncovered, i.e., exposed. When the cover frame 806 pivots away from the endoscope 60, the foldable cover 8096 is expanded and the shovel 402 is covered. According to another embodiment illustrated in FIG. 14D, the shovel cover 80 further includes a frame arm 870. An embodiment of the frame arm 870 has been described above in relation to FIGS. 14B-14C. According to an additional embodiment, the foldable cover 8096 illustrated in FIG. 14D is attached to two frames, similar to the shovel cover 80 illustrated in FIGS. 14A-14C.

[0102] According to one embodiment, a foldable shovel cover 80, including any embodiment of the foldable shovel cover 80 described above, is configured to treat a target tissue 520. Any type of treatment of the target tissue 520 that can be performed by the foldable shovel cover 80 is within the scope of the present subject matter. According to one embodiment, the foldable shovel cover 80 is configured to elevate the target tissue 520. According to another embodiment, the foldable shovel cover 80 is configured to push the target tissue 520. According to yet another embodiment, the foldable shovel cover 80 is configured to perform any treatment of the target tissue 520 that enables visualization of the target tissue 520 by an imaging device. According to still another embodiment, the foldable shovel cover 80 is configured to perform any treatment of the target tissue 520 that enables accurate incision of the target tissue 520, for example, by a cutting tool 300. Generally, the foldable shovel cover 80 is configured to assist in controlling the position and state of the target tissue 520 during treatment of the target tissue 520. According to an additional embodiment, the first frame 801 of the foldable shovel cover 80 is configured to perform the aforementioned embodiments regarding control of the position and state of the target tissue 520.

[0103] Next, referring to FIGS. 15A - 15B, which schematically show a side perspective view of an upwardly pivoting shovel and a downwardly pivoting shovel, respectively, according to one exemplary embodiment. The former figure shows a shovel 402 aligned with the length of the endoscope 60. In FIGS. 15A - 15B, the dotted line 910 indicates the line of the length of the endoscope 60. According to one embodiment illustrated in FIGS. 15A - 15B, the shovel 402 is axially attached to the connector 404 by a horizontal axis 450 located at the bottom of the connector 404. This horizontal axis 450 enables upward, or downward, or both upward and downward pivoting of the shovel 402.

[0104] FIG. 15A illustrates a shovel 402 configured to pivot upward. In FIG. 15A, the dotted line 912 indicates the line of the length of the shovel 402 when the shovel 402 pivots upward, and the angle 913 is the angle formed between the line 910 of the length of the endoscope and the line 912 of the length of the shovel pivoted upward.

[0105] FIG. 15B illustrates a shovel 402 configured to pivot downward. In FIG. 15B, the dotted line 914 indicates the line of the length of the shovel 402 when the shovel 402 pivots downward, and the angle 915 is the angle formed between the line 910 of the length of the endoscope and the line 914 of the length of the shovel pivoted downward.

[0106] According to another embodiment, the shovel 402 is configured to pivot upward as shown in FIG. 15A and pivot downward as shown in FIG. 15B. The embodiments shown in FIGS. 15A-15B provide flexibility in the function of the tool and increase the area of the target tissue 520 that can be treated by the tool without the need to move the endoscope 60.

[0107] Next, referring to FIG. 16A, which schematically shows a front perspective view of a shovel configured to pivot laterally according to one exemplary embodiment. The dotted line 910 indicates the line of the length of the endoscope 60. According to one embodiment shown in FIG. 16A, the shovel 402 is axially attached to the connector 404 by a vertical axis 470 located at the boundary between the shovel 402 and the connector 404. This vertical axis 470 allows the shovel 402 to pivot rightward, or leftward, or both rightward and leftward.

[0108] FIG. 16A illustrates a shovel 402 configured to pivot rightward. In FIG. 16A, the dotted line 916 indicates the line of the length of the shovel 402 when the shovel 402 pivots rightward, and the angle 917 is the angle formed between the line 910 of the length of the endoscope and the line 917 of the length of the shovel pivoted rightward. Similarly, according to another embodiment, the shovel 402 is configured to pivot leftward and forms an angle between the line 910 of the length of the endoscope and the line of the length of the shovel pivoted leftward. Although this particular embodiment is not illustrated, it is easy to visualize an embodiment of the shovel 402 pivoting leftward based on the shovel 402 pivoting rightward illustrated in FIG. 16A. The advantages of the shovel 402 configured to pivot rightward, or leftward, or rightward and leftward are shown in FIG. 16B below.

[0109] Next, referring to FIG. 16B, which schematically shows a side perspective view of a shovel configured to pivot rightward, leftward, or both rightward and leftward to incise a target tissue. FIG. 16B shows a significant advantage of the shovel 402 configured to pivot rightward, leftward, or both rightward and leftward. This embodiment dramatically increases the area that can be affected by a tool carried by the endoscope 60 and including a shovel 402 configured to pivot rightward, leftward, or both rightward and leftward. For example, when the tool is the cutting tool 300, the function of the laterally pivoting shovel 402, as described above, increases the size of the incision 522 in the target tissue 520 that can be made as compared to an endoscope 60 including a fixed shovel 402 and, in particular, as compared to a prior art endoscope 60 not including a shovel 402. As described above, the shovel 402 enables the tool, such as the cutting tool 300, to move end-to-end within the width of the shovel 402 without the need to move the endoscope 60. This is advantageous over prior art endoscopes 60 that do not include a shovel 402 and, as a result, require the entire endoscope 60 to be moved laterally to achieve a long, continuous incision 522 where the cutting tool 300 is fixed. Here, the embodiments shown in FIGS. 16A-16B further increase the affected area of the tool and, for example, dramatically increase the size of the incision 522 without the need to move the endoscope 60.

[0110] Next, referring to FIGS. 17A - 17B which schematically show a front perspective view of a foldable shovel in a folded state and an open state, respectively, according to one exemplary embodiment. FIG. 17A illustrates an endoscope 60 inserted into the cavity 550 and directed towards the target tissue 520. The endoscope 60 is in a folded state and includes a foldable shovel 402 located inside the endoscope 60. The foldable shovel 402 is maintained in a folded state during the conveyance of the endoscope towards the target tissue 520 in the cavity 550. When the endoscope 60 approaches the target tissue 520, the foldable shovel 420 is moved out from the endoscope 60, spreads or opens to form the open state illustrated in FIG. 17B. In the open state, the foldable shovel 420 extends laterally beyond the width of the endoscope 60. Any mechanism for folding the foldable shovel 402 is within the scope of the present subject matter. According to the exemplary embodiment illustrated in FIG. 17B, the foldable shovel includes at least one shovel axis. For example, the foldable shovel 402 illustrated in FIG. 17B includes two shovel axes, namely a first shovel axis 4027 and a second shovel axis 4029. According to one embodiment, the foldable shovel 402 is configured to be folded at at least one shovel axis. Thus, as described above, when the endoscope 60 is conveyed in the cavity 550, the foldable shovel 402 is folded, for example, to prevent contact of the shovel 402 with the tissue during the conveyance of the endoscope 60 and is maintained inside the endoscope 60. When the endoscope 60 reaches the target tissue 520, the foldable shovel 402 is moved out from the endoscope 60 and opened, for example, to incise the target tissue 520 or to perform any other procedure by the foldable shovel 402 in the open state. After the procedure on the target tissue 520 is completed, the foldable shovel 402 is folded back to the closed state as illustrated in FIG. 17A and pushed back inside the endoscope 60.Any mechanism for moving the foldable shovel 402 inside and outside the endoscope 60, as well as any mechanism for opening the foldable shovel 402 and returning the foldable shovel to the closed state, is within the scope of the present subject matter.

[0111] Next, referring to FIGS. 18A - 18C, which schematically show a front perspective view of a shovel with a swiveling sub - shovel in three states according to one exemplary embodiment. According to one embodiment illustrated in FIGS. 18A - 18C, the shovel 402 further includes a swiveling sub - shovel 403 that is positioned above or below the shovel 402 and configured to swivel laterally. The advantage of this embodiment is that it allows the width of the shovel 402 to extend beyond, for example, the width of the endoscope 60, thereby increasing the area that can be treated by a tool, such as the cutting tool 300. FIG. 18A illustrates the shovel 402 described above and the swiveling sub - shovel 403 installed on the shovel 402. In this position, the swiveling sub - shovel 403 does not extend beyond the shovel 402. In FIG. 18B, the swiveling sub - shovel 403 swivels to the right and thus extends beyond the right side of the shovel 402. In FIG. 18C, the swiveling sub - shovel 403 swivels to the left and thus extends beyond the left side of the shovel 402. According to one embodiment, when the width of the swiveling sub - shovel 403 is similar to the width of the shovel 402, the swiveling sub - shovel 403 can extend the operating width of the shovel 402 up to three times. In other words, in an embodiment using, for example, the cutting tool 300, by first swiveling the swiveling sub - shovel 403, for example, to the right and then to the left, the swiveling sub - shovel 403 can increase the length of the incision 522 made by the cutting tool 300 up to three times while keeping the endoscope 60 fixed in place.

[0112] As can be further seen in FIGS. 18B - 18C, the swing sub - excavator 403 is similar to the excavator 402. For example, the swing sub - excavator 403, like the excavator 402, includes a boom rail 113. As a result, a tool, such as the cutting tool 300, can move along the boom rail 113 of the excavator 402 and on the boom rail 113 of the swing sub - excavator 403 when the swing sub - excavator 403 is swung laterally right - ward as shown in FIG. 18B or left - ward as shown in FIG. 18C.

[0113] As described above, according to one embodiment illustrated in FIG. 18A, the swing sub - excavator 403 is positioned below the excavator 402. According to another embodiment, the swing sub - excavator 403 is positioned above the excavator 402. Although there is no drawing illustrating the swing sub - excavator 403 positioned above the excavator 402, this embodiment can be easily understood from FIGS. 18A - 18C.

[0114] Next, referring to FIGS. 19A-19B, which schematically show a front perspective view of an endoscope including a shovel and a multi-barrel cutting tool, and a side perspective close-up view of the shovel and the multi-barrel cutting tool, respectively, according to one exemplary embodiment. FIG. 19A illustrates an endoscope 60 including the shovel 402 described above and a cutting tool 300 in the form of a multi-barrel cutting tool 300. According to this embodiment, the cutting tool 300 is a radiofrequency (RF) cutting tool 300 or a diathermy cutting tool 300. Such a cutting tool 300 is configured to incise tissue by heating the tissue with radiofrequency or at a high temperature. Similarly, the cutting tool 300 already shown in FIGS. 18A-18C, for example, may also be an RF cutting tool 300 or a diathermy cutting tool 300. This cutting tool 300 includes a single barrel that emits RF or heats the tissue. As a result, as described above, it is necessary to move the cutting tool 300 along the shovel 402 to incise the target tissue 520. However, the advantage of the shovel 402 is that it enables the use of the multi-barrel cutting tool 300. According to this embodiment, the multi-barrel cutting tool 300 includes a plurality of barrels 302 disposed on the shovel 402. When it is necessary to incise the target tissue, for example, at least one barrel 302 located beside the shovel 402 is activated, for example, to transmit RF or heat toward the target tissue 520. Accordingly, the target tissue 520 is incised within the range of the activated at least one barrel 302. Then, to continue incising the target tissue 520, this at least one barrel 302 is stopped, and at least one barrel 302 located beside the first at least one barrel 302 is activated, thus incising the target tissue 520 at a position beside the first incision. Accordingly, in this way, by alternately activating the barrels 302 as described above, incisions can be made along the width of the shovel 402. This embodiment of the multi-barrel cutting tool 300 eliminates the need for mechanical movement of the cutting tool 300 as already described, and thus makes the incision of the target tissue 520 faster and more accurate.

[0115] Next, referring to FIG. 20, which schematically shows a front perspective view of an endoscope comprising a spatula, a multi-barrel cutting tool, and a spatula cover, according to one exemplary embodiment. The endoscope 60 illustrated in FIG. 20 includes a spatula 402 and a multi-barrel cutting tool, as in the embodiment illustrated in FIGS. 19A-19B, and includes a spatula cover 80, as illustrated, for example, in FIG. 12. According to one embodiment, the spatula cover 80 is transparent and enables imaging by a prior art imaging device of the endoscope.

[0116] Next, referring to FIG. 21, which schematically shows a side perspective view of an endoscope comprising a spatula, a multi-barrel cutting tool, and a spatula cover for incising a target tissue, according to one exemplary embodiment. Incision of the target tissue 520 by the multi-barrel cutting tool 300 is performed as already described in connection with FIGS. 19A-19B. During incision of the target tissue 520, a portion of the target tissue slides over the cover 80, thus enabling deeper incision of the target tissue 520 on the one hand, compared to a prior art endoscope 60, and preventing contact between components of the endoscope 60, such as the spatula 402 and the multi-barrel cutting tool 300, and the tissue on the other hand.

[0117] Next, referring to FIG. 22, which schematically shows an endoscope comprising a circular spatula and a circular multi-barrel cutting tool for incising a target tissue, according to one exemplary embodiment. According to one embodiment illustrated in FIG. 22, the spatula 402 is a circular spatula 402-C extending from the distal edge of the endoscope 60. According to another embodiment, the multi-barrel cutting tool 300 is attached to the circular spatula 402-C, and thus the multi-barrel cutting tool 300 is a circular multi-barrel cutting tool 300-C. The circular spatula 402-C and the circular multi-barrel cutting tool 300-C obviate the need to move the endoscope or a prior art cutting tool 300 during incision of the target tissue 520, enabling incision of an entire portion of the target tissue 520 while keeping the endoscope 60 in a fixed predetermined position. This is significantly advantageous over prior art endoscopes 60 that are unable to incise an entire portion of the target tissue 520 while keeping the endoscope 60 in a fixed predetermined position.

[0118] As shown in FIG. 22, the endoscope 60 is inserted into the cavity 550, and the circular shovel 402-C extends outward from the endoscope 60, while the circular multi-bar cutting tool 300-C is incising an overall portion of the target tissue 520 while keeping the endoscope 60 in a fixed predetermined position. The additional embodiment illustrated in FIG. 22 relates to the field of view 725 of the imaging device of the endoscope 60. According to one embodiment, the overall circular shovel 302-C, along with the overall circular multi-bar cutting tool 300-C, is within the field of view 725 of the imaging device of the endoscope 60. This embodiment enables visual inspection by the operator of the process of incising the overall portion of the target tissue 250 described above.

[0119] Next, referring to FIG. 23, which schematically shows a side perspective view of an endoscope having a shovel and a lifting element, according to one exemplary embodiment. According to one embodiment, the shovel 402 further comprises a lifting element 26 configured to lift the target tissue 520, for example during the treatment of the target tissue 520. According to another embodiment, the lifting element 26 comprises a tissue engagement element 262 configured to engage the target tissue 520 when lifting the target tissue 520. According to another embodiment, the tissue engagement element 262 has a high coefficient of friction. This embodiment is important to enable a firm engagement of the tissue engagement element 262 with the target tissue 520 and to avoid slippage of the target tissue 520 from the tissue engagement element 262 during the lifting of the target tissue 520.

[0120] According to one embodiment, the lifting element 26 is configured to be in an ascending state and a descending state. Any mechanism for raising and lowering the lifting element 26, and more specifically, for raising and lowering the tissue engagement element 262, is within the scope of the present subject matter. Such an exemplary mechanism is illustrated in FIG. 23. Thus, according to one embodiment, the lifting element 26 includes at least one lifting arm 264, for example, two lifting arms 264 as illustrated in FIG. 23, one side of which is attached to the tissue engagement element 262, and the opposite side is axially connected to the endoscope 60, or to the distal edge 62 of the endoscope, or to the connector 404 of the shovel 402. According to a further embodiment, the lifting element 26 is directly or indirectly connected to the operator of the endoscope 60 by a lifting cable 266, for example via a motor. According to one embodiment, the lifting cable 266 is attached to the tissue engagement element 262 as illustrated in FIG. 23. According to another embodiment, the lifting cable 266 is attached to at least one lifting arm 264.

[0121] Next, referring to FIGS. 24A-24B, which schematically show a side perspective view of an endoscope comprising a shovel and a lifting element in a descending state and a lifting element in an ascending state lifting a target tissue, respectively. FIG. 24A illustrates the endoscope 60 positioned adjacent to the target tissue 520 when the cutting tool 300 forms an incision 522 in the target tissue 520, such that as a result, a portion of the target tissue 520 rides over the shovel 402 and the connector 404. Additionally, the lifting element 26 is in a descending state, and the tissue engagement element 262 is positioned under a portion of the target tissue 520 that rides over the shovel 402 and the connector 404 at the incision 522.

[0122] In FIG. 24B, the lifting element 26 is in the raised state. This is achieved, for example, by pulling the lifting cable 266 attached to the tissue engagement element 262 according to the embodiment illustrated in FIGS. 23 and 24A-24B. When the lifting element 26 is in the raised state, the tissue engagement element 262 engages with the target tissue 520, and in particular, with a part of the target tissue 520 that rides on the shovel 402 and the connector 404, and lifts the target tissue 520. The embodiment illustrated in FIG. 24B shows the advantages of the lifting element 26. By lifting the target tissue 520, there is a possibility of further incising the target tissue with the cutting tool 300 and widening the incision 522 deeper in the target tissue 520. In addition, the use of the lifting element 26 allows for the removal of tissue that may block the movement of the endoscope 60 inside the cavity 550.

[0123] Next, referring to FIG. 25, which schematically shows a side perspective view of a shovel with an endoscope and a suction lifting element according to one exemplary embodiment. According to one embodiment, the shovel 402 includes a suction lifting element 27 configured to engage with the target tissue 520 by suction force and lift or laterally move the engaged target tissue 520. According to one embodiment, the suction lifting element 27 has a nozzle-like structure attached to the endoscope 60. According to another embodiment, the suction lifting element is attached to the shovel cover 80 or to the connector 404 of the shovel 404. These embodiments are not illustrated in FIG. 25 but can be easily understood from FIG. 25.

[0124] According to one embodiment, the suction lifting element 27 is configured to move or tilt in various directions indicated by the arrows in FIG. 25. Arrow 752 indicates that the suction lifting element 27 is configured to move back and forth along the length of the endoscope 60. Arrow 754 indicates that the suction lifting element 27 is configured to rotate left and right with respect to the length of the endoscope 60. Arrow 756 indicates that the suction lifting element 27 is configured to move upward and downward. This diversity in the movement capabilities of the suction lifting element 27 provides a great deal of freedom when engaging the target tissue 520 from different positions, and in addition, provides a great deal of freedom in the movement of the target tissue 520 after engagement with the suction lifting element 27.

[0125] According to one embodiment, the suction lifting element 27 includes a tissue suction element 272 located at the distal end of the nozzle-like structure of the suction lifting element 27. The suction lifting element 27 is hollow, and the tissue suction element 272 is an opening at the distal end of the suction lifting element. The tissue suction element 272 is configured to engage the target tissue 520, and then the suction operation in the suction lifting element 27 results in the formation of a vacuum force in the tissue suction element 27, and the target tissue 520 is held by the suction lifting element 27. When there is a desire to remove the target tissue 520 from the tissue suction element 272, the suction operation through the suction lifting element 27 is terminated, and as a result, the vacuum force in the tissue suction element 272 dissipates, and the target tissue 520 is removed from the tissue suction element 272. The figures of these embodiments are given in FIGS. 26A - 26B below.

[0126] According to one embodiment, the suction lifting element 27 further includes at least one protrusion 274 on the upper side of the suction lifting element 27. The at least one protrusion 274 enables engagement with the target tissue 520 in a manner similar to the engagement of the tissue engagement element 262 described above in FIGS. 23 and 24A - 24B.

[0127] Next, referring to FIGS. 26A - 26B, which schematically show a side perspective view of an endoscope having a suction lifting element that engages a target tissue in a descending state and an ascending state, respectively, according to one exemplary embodiment. FIG. 26A shows an endoscope 60 positioned near a target tissue 520 and incising the target tissue 520 with a cutting tool 300, thereby forming an incision 522 in the target tissue 520. In addition, the suction lifting element 27 is lowered downward and the tissue suction element 272 is engaged with the target tissue 520.

[0128] In FIG. 26B, after the target tissue 520 is suctioned by the tissue suction element 272, the suction lifting element 27 rises to an ascending position. This enables the incision 522 in the target tissue 520 by the cutting tool 300 to be made deeper. Although FIG. 26B only illustrates the bulge of the target tissue 520 suctioned by the suction lifting element 27, it should be noted that the suction lifting element 27 is configured to move in any desired direction, as described in FIG. 25, and thus the suctioned target tissue 520 can also be moved in any desired direction.

[0129] Another embodiment relates to at least one protrusion 274. According to one embodiment, at least one protrusion 274 is located on the upper side of the suction lifting element 27, as illustrated in FIG. 25. According to another embodiment, at least one protrusion 274 is located on the bottom side of the suction lifting element 27, as illustrated in FIG. 26B. According to yet another embodiment, at least one protrusion 274 is located on both the upper side and the bottom side of the suction lifting element 27.

[0130] According to one embodiment, at least one protrusion 274 has a high coefficient of friction and is configured to engage the target tissue 520 in such a way that there is no slippage of the target tissue 520 from the at least one protrusion 274 and the target tissue maintains engagement with the at least one protrusion 274. According to another embodiment, at least one protrusion 275 is made of a material having a high coefficient of friction on its surface, such as silicon, or a material similar to silicon.

[0131] Demonstration of the advantages of at least one protrusion 274 in the removal of target tissue 520 by the suction lifting element 27 is illustrated in FIG. 26B. FIG. 26B illustrates the suction lifting element 27 engaged with the target tissue 520 by suction through the tissue suction element 272. Engagement with the target tissue 520 occurs inside the incision 522 made in the target tissue 520. Then, during the lifting of the target tissue 520 by lifting the suction lifting element 27, a portion of the target tissue 520 engages with at least one protrusion 274 located on the bottom side of the suction lifting element 27. Since the target tissue remains engaged with the at least one protrusion 274, the target tissue 520 can be lifted, folded upward, and pushed forward to provide access to, for example, the cutting tool 300, for example, to make the incision 522 deeper.

[0132] The present subject matter additionally provides several improvements to a system for enabling access to all sides of the raised tissue 520. Here, a general description of a system for enabling access to all sides of the raised tissue is provided, followed by a detailed description of several improvements in this system. For the sake of simplicity only, the system for enabling access to all sides of the raised tissue 520 may hereinafter sometimes be referred to as "System 1".

[0133] According to one embodiment, the system 1 is configured to enable access to various tools to all sides of the raised tissue 520. Some exemplary tools include an incision tool, a grasping tool, an imaging tool, an injection tool, a cautery tool, and the like.

[0134] In some embodiments, the system 1 of the present subject matter enables an incision of the raised tissue 520 in a patient's body and separation from the surface tissue 510. In some other embodiments, the system 1 of the present subject matter further enables removal of the incised and separated raised tissue 520 from the patient's body.

[0135] According to one embodiment, the patient is an animal, particularly a vertebrate. According to another embodiment, the animal is a human.

[0136] As disclosed herein, the term "tool" refers to any type of tool configured to be used during the treatment of tissue in a patient's body. Some exemplary types of tools include an incision tool configured to incise tissue, a grasping tool configured to grasp tissue pieces, a containment tool configured to contain an object, such as a tissue piece, during removal of the object from the patient's body, an imaging tool configured to acquire an image inside the patient's body, an illumination tool configured to illuminate the inside of the patient's body, an injection tool configured to inject a substance into tissue, a cautery tool configured to cauterize a part of tissue, and combinations thereof.

[0137] Next, referring to FIG. 27, which schematically shows a system for enabling controlled access of tools to all sides of a raised tissue in a patient's body according to one exemplary embodiment. FIG. 27 shows the components of a system 1 for enabling controlled access of tools to all sides of the raised tissue 520 in a patient's body, and the system 1 includes a rail 110 configured to surround the raised tissue 520 inside the patient's body, and At least one transport means 120 configured to move along a rail 110 and carry at least one tool configured to treat the raised tissue comprises.

[0138] According to one embodiment, at least one connector 122 is attached to the transport means 120 and configured to connect at least one tool to the transport means 120.

[0139] According to one embodiment, the tool is an integral part of the transport means 120. According to another embodiment, the tool is separate from the transport means and configured to connect to the transport means 120.

[0140] As seen in FIG. 27, the surface tissue 510 is part of a cavity in the patient's body, and the raised tissue 520 extends from the surface tissue 510. The rail 110 surrounds the raised tissue 520, and the transport means 120 is attached to the rail 110 and is stationary or moves along the rail 110. Since the rail 110 surrounds the raised tissue 520 and the transport means 120 is configured to move along the rail 110, the transport means 120 can surround the raised tissue 520. Thus, the system 1 enables access of the transport means 120 to at least a part of the raised tissue 520, up to all sides of the raised tissue 520 at most, thereby enabling treatment of the raised tissue 520 depending on the tool connected to the transport means 120.

[0141] The zoomed-in image enclosed by a circle in FIG. 27 also shows at least one connector 122 attached to the transport means 120. Thus, the system 1 enables access of any tool connected to the connector 122 to at least a part of the raised tissue 520, up to all sides of the raised tissue 520 at most.

[0142] According to one embodiment, the rail 110 and the transport means 120 are configured to be inserted into the patient's body. According to another embodiment, the rail 110 and the transport means 120 are configured to be inserted into a cavity in the patient's body. According to yet another embodiment, the rail 110 and the transport means 120 are configured to be manually inserted into the patient's body or into a cavity in the patient's body. According to a further embodiment, the rail 110 is configured to be inserted into the patient's body or into a cavity in the patient's body through an endoscope. According to yet a further embodiment, the transport means 120 is configured to be inserted into the patient's body or into a cavity in the patient's body through an endoscope. According to yet a further embodiment, both the rail 110 and the transport means 120 are configured to be inserted into the patient's body or into a cavity in the patient's body through an endoscope. According to a further embodiment, the insertion of the rail 110, the insertion of the transport means 120, or the insertion of both the rail 110 and the transport means 120 can be manual or autonomous, i.e., performed by a robotic mechanism. According to an additional embodiment, the rail 110 or the transport means 120, or both the rail 110 and the transport means 120, are configured to be inserted into the patient's body or into a cavity in the patient's body through a multi-lumen conveyed through an endoscope.

[0143] Next, referring to FIG. 28, which schematically shows a rail surrounding a raised tissue and protruding from an endoscope inserted into a cavity of a patient's body, according to one exemplary embodiment. FIG. 28 shows an endoscope 60 inserted into a cavity of a patient's body. Thus, the surface tissue 510 is the tissue of the cavity. As seen in FIG. 28, the endoscope 60 has a tubular structure. The endoscope 60 includes at least one, but preferably a plurality of channels 601, 602, 603 through which a rail 110, a tool, or a combination of the rail 110 and the tool can be conveyed. Further seen in FIG. 28 is a rail 110 that exits from channel 601 of the endoscope 60 and surrounds the raised tissue 520 that extends over the surface tissue 510. In other words, FIG. 28 shows an exemplary embodiment of a rail 110 configured to be inserted into a patient's body or into a cavity in the patient's body through the endoscope 60, for example via a multi-lumen 70. In this embodiment, during insertion of the endoscope 60 into the patient's body, the rail 110 is present inside the channel 601 of the multi-lumen 70 inserted into the endoscope 60. When the endoscope 60 approaches the vicinity of the raised tissue 520, as seen in FIG. 29, the multi-lumen 70 can exit the endoscope, and then the rail 110 can exit from the channel 601 in which the rail 110 is present and surround the raised tissue 520.

[0144] Next, referring to FIG. 29, which schematically shows a rail emerging from a multi-lumen approaching the raised tissue, according to one exemplary embodiment. FIG. 29 shows an internal cavity having a surface tissue 510 and a raised tissue 520 extending over the surface tissue 510. Also shown is a multi-lumen 70 protruding from the endoscope 60 and approaching the vicinity of the raised tissue 520. During insertion of the endoscope 60 into the cavity, the multi-lumen 70 is present inside the working channel 601 of the endoscope 60, and the rail 110 is present in the multi-lumen 70 that is inside the working channel 601 of the endoscope 60. When the endoscope 60 approaches the vicinity of the raised tissue 520, the rail 110 can emerge from the channel 601 of the multi-lumen 70 towards the raised tissue. FIG. 29 shows the edge of the rail 110 emerging from the channel 601 of the endoscope 60. The rail 110 is configured to surround the raised tissue 520 after emerging from the channel 601. It should be noted that hereinafter it will be described that the rail 110 is present inside the endoscope 60. This description includes all embodiments of the accommodation of objects in the endoscope, such as the working channel 601 and the multi-lumen 70.

[0145] It should also be noted that the insertion of the rail 110 into the vicinity of the raised tissue 520 within the body by use of the endoscope 60 is merely exemplary and should not be considered as limiting the scope of the subject matter, whether or not a multi-lumen 70 is used in the endoscope 60. The rail 110 can be moved in a similar manner to the vicinity of the raised tissue 520 by any other mechanism, for example, manually during a bleeding operation, or by any other means, such as robotic arms, forceps, and combinations thereof.

[0146] According to one embodiment, the system 1 is separable. A capsule containing at least one component of the system 1 can be transported by the endoscope to a target location in the patient's body, separated from the endoscope, and left at the target location. Then, the components contained in the capsule, such as rails, transport means, and tools attached to the transport means, can exit the capsule and operate at the target location.

[0147] The following are some improvements of the rail 110.

[0148] Next, referring to FIG. 30A, which schematically shows a perspective view of a rail comprising a track and a plurality of fasteners extending from the track, according to one exemplary embodiment. FIG. 30A shows a rail 110 comprising a track 102 and a plurality of fasteners 104 extending from the track 102. According to one embodiment, the track 102 is configured to enable the movement of the transport means 120 along the track 102. In other words, the transport means 120 is configured to contact the track 102 and move along the track 102.

[0149] Next, referring to FIG. 30B, which schematically shows an enlarged view of the track illustrated in FIG. 30A, according to one exemplary embodiment. According to one embodiment illustrated in FIG. 30B, the track 102 may have a substantially U-shaped profile configured to contact the transport means 120 and enable the movement of the transport means 120 along the track 102.

[0150] Next, return to FIG. 30A. The rail 110 illustrated in FIG. 30A is in an expanded state, and most of the rail 110 is folded substantially circularly. In this state, the substantially circularly folded portion of the rail 110 is configured to surround the raised tissue 520, essentially as illustrated in FIGS. 2 and 3. According to one embodiment, the substantially circularly folded state of the rail 110 is the default state of the rail 110. In other words, the rail 110 tends to always return to a substantially circularly folded state. When the rail 110 is housed inside the endoscope 60, the rail 110 is forced into a shape determined by the shape of the endoscope 60, for example, a straight shape, because the rail 110 is forced to conform to the shape of the endoscope 60. However, as illustrated in FIG. 29 showing the rail 110 at an early stage after exiting the endoscope 60, when the rail 110 is pushed out from the endoscope 60, for example, in the vicinity of the raised tissue 520, the rail 110 tries to return to its default substantially circularly folded state, thereby surrounding the raised tissue 520.

[0151] Still referring to FIG. 30A, as described above, the rail 110 includes a plurality of fasteners 104 extending from the track 102. According to one embodiment, the fasteners 104 extend substantially perpendicular to the track 102. According to another embodiment, the fasteners 104 extend from a part of the track 102 configured to be in a substantially circularly folded state, that is, from a part of the track 102 configured to surround the raised tissue 520. According to yet another embodiment, the fasteners 104 extend from both sides of the track 102. In other words, there are fasteners 104 that extend towards the inner circle of the rail 110 and towards the raised tissue 520 surrounded by the rail 110, and there are fasteners 104 that extend outside the circle of the rail 110 and away from the raised tissue 520 surrounded by the rail 110.

[0152] According to one embodiment, the fastener 104 is configured to stabilize the rail 110 when the rail 110 surrounds the raised tissue 520. This embodiment is achieved by increasing the contact area of the rail 110 with the tissue by the fastener 102. Additionally, the individual fasteners 104 that contact the tissue are somewhat fixed to the tissue and thus further stabilize the rail 110 in place. According to another embodiment, the fasteners 104 are configured not to harm the tissue they contact. For example, the edges of the fasteners are not sharp so as not to pierce and damage the tissue. Another example could be that the fastener 104 has an elasticity such that the fastener 104 bends when pressure is applied to the tissue.

[0153] Next, referring to FIG. 30C, which schematically shows an enlarged view of the track and fasteners illustrated in FIG. 30A according to one exemplary embodiment. FIG. 30A shows some of the dimensions of the fastener 104. The fastener 104 has a length 104-L, which is the distance between the track 102 from which the fastener 104 extends and the distal edge 104-E of the fastener 104, a width 104-W as seen in FIG. 30C, and a height 104-H as seen in FIG. 30C, and there is a gap 104-G between adjacent fasteners 104. According to one embodiment, the dimensions of the fastener 104, along with the type of material from which the rail 110 is made, determine the level of elasticity and rigidity of the rail 110, particularly in the portion of the rail 110 that has a default substantially circularly folded state.

[0154] Next, referring to FIG. 31, which schematically shows a perspective view of a rail comprising a transport means on or moving along a rail and a plurality of fasteners extending from the track and surrounding the raised tissue while cutting the raised tissue. FIG. 31 illustrates a rail 110 emerging from the endoscope 60 and surrounding the raised tissue 520. It is well illustrated how the fasteners 104 of the rail 110 contact the surface tissue 510 and the raised tissue 520, thereby stabilizing the rail 110 in place. In FIG. 31, a transport means 120 on or moving along the rail 110 and cutting the raised tissue is further illustrated. The circular arrow 910 represents an exemplary trajectory 910 of the transport means 120 along the rail 110. The dashed line 521 represents a predetermined or pre-planned cutting line 521 of the raised tissue 520 to be cut by a cutting tool attached to the transport means 120.

[0155] In an experiment conducted using a rail 110 without the fastener 104 illustrated in FIG. 27 and a transport means 120 to which a cutting tool 300 was attached, the raised tissue 520, particularly the soft raised tissue 520, collapsed onto the rail 110, blocking the movement of the transport means 120 along the rail 110, and thus tended to interfere with the cutting of the raised tissue. However, in a similar experiment conducted using a rail 110 provided with a track 102 and a plurality of fasteners 104 extending from the track 104 illustrated in FIG. 31, the fasteners 104 removed the raised tissue 520 from the track 102, and thus it was found that free movement of the transport means 120 along the rail 110 and unobstructed cutting of the raised tissue 520 were possible. Therefore, according to one embodiment, the fastener 104 is configured to remove tissue from the rail 110 and enable unobstructed movement of the transport means 120 along the rail 110. More specifically, the fastener 104 is configured to remove tissue on both sides of the rail 110, that is, on the side in contact with the raised tissue 520 and on the side of the fastener 104 extending away from the raised tissue 520. This creates a passage for smooth movement of the transport means 120 along the rail 110 on both sides of the rail 110.

[0156] Another feature of the fastener 104 is that the fastener 104 increases the contact area of the rail 110 with the tissue, thereby increasing the stability of the rail 110. High stability of the rail 110 is particularly important during the treatment of the raised tissue 520, for example, during the cutting of the raised tissue 520.

[0157] In addition, it has been found that the fastener 104 promotes the formation of raised tissue having a symmetric structure even when the raised tissue is asymmetric in nature. The symmetric structure of the raised tissue 520 is advantageous as it enables more accurate cutting of the raised tissue 520. In addition, it has been found that the fastener 104 promotes the formation of the raised tissue 520 in the shape of a distinct mushroom, which is a preferred shape of the target tissue in the technical field of tissue incision in patients.

[0158] Furthermore, it has been found that the fastener 104 can create a linear trajectory on tissue even when the tissue is not planar, but rather has folds, such as in the stomach or intestine, or is not straight by nature. This linear trajectory is advantageous because it provides a linear trajectory to the transport means 120 for smooth movement even in tissue having folds.

[0159] Next, referring to FIG. 32, which schematically shows a top view of a rail having a track and a plurality of fasteners extending from the track, emerging from an endoscope and having various stages of extension, according to one exemplary embodiment. FIG. 32 shows a rail 110 emerging from the endoscope 60 and taking on the default substantially circular shape described above. During the process of cutting the raised tissue 520 by the cutting tool 300 attached to the transport means 120 traveling along the rail 110, the diameter of the raised tissue 520 at the cutting line 521 (see FIG. 31) is reduced. Accordingly, in order to allow the cutting tool 300 to continue to contact the raised tissue 520 at the cutting line 521 to further cut the raised tissue 520, the diameter of the circle formed by the rail 110 must be reduced. This is accomplished by pulling the rail 110 back into the endoscope 60 during the cutting of the raised tissue 520 in order to reduce the diameter of the circular rail 110.

[0160] During the cutting of the raised tissue 520, pulling the rail 110 back into the endoscope 60 is performed by the operator of the system 1. According to one embodiment, the operator can obtain a visual image of the raised tissue 520 incised during cutting by the camera of the endoscope 60, and according to this image, determine when there is a need to pull the rail 110 and how much to pull to tightly grip the raised tissue 520. For example, the operator can compare the visual image of the raised tissue with a pre-planned image of the surgical stage to determine when and how to pull the rail 110. The operator can also determine the distance between the boundary to the raised tissue 520 and the track 102 or the fastener 104. When this distance is greater than a specific predetermined value, the rail 110 needs to be pulled until the distance is close enough. In addition, the operator can see the level at which the fastener 104 is covered by the raised tissue 520. When the fastener 104 is at least partially covered by the raised tissue 520, this indicates that the rail 110 is close enough to the raised tissue 520 and there is no need to pull the rail 110. On the other hand, when the fastener 104 is exposed, this indicates that the rail 110 is far from the raised tissue 520 and it is necessary to pull the rail 520 to tightly grip the raised tissue 520 by the rail 110.

[0161] According to another embodiment, a pressure sensor or a contact sensor can be attached to the rail 110, for example, to the fastener 104. When pressure is detected by the pressure sensor, or when contact is detected by the contact sensor, this indicates that the fastener 104 is covered by the raised tissue 520 and there is no need to pull the rail 110. On the other hand, when a lower pressure is detected in the pressure sensor, or when contact is not detected by the contact sensor, this indicates that the rail is away from the raised tissue 520 and it is necessary to pull the rail 110 to bring it closer to the raised tissue 520.

[0162] According to yet another embodiment, the operator can sense the force he uses to pull the rail 110. When the rail 110 is far from the raised tissue 520, the resistance to the pulling force exerted on the rail 110 becomes lower. This indicates to the operator that the rail 110 needs to be further pulled until the rail 110 contacts the raised tissue 520 and the resistance to the pulling force exerted on the rail 110 increases.

[0163] The dashed lines 110-A, 110-B, and 110-C represent various positions of the rail 110 during the process of cutting the raised tissue 520. The line 110-A represents the initial state when the rail 110 just surrounds and raises the raised tissue 520. The line 110-B represents the intermediate state when the raised tissue 520 is partially cut and the diameter of the cutting line 521 of the raised tissue 520 is reduced. At this stage, the rail 110 is partially retracted into the endoscope 60, and as a result, the circle of the rail 110 corresponds to the dashed line 110-B. The line 110-C represents the final state when the raised tissue 520 is almost completely cut and the diameter of the cutting line 521 of the raised tissue 520 is further reduced. At this stage, the rail 110 is further retracted into the endoscope 60, and as a result, the circle of the rail 110 corresponds to the dashed line 110-C. In FIG. 32, the endoscope 60 is shown in a transparent view, and a part of the rail 110 retracted into the endoscope 60 is also illustrated.

[0164] Still referring to FIG. 32. According to one embodiment, the fastener 104 is foldable and can be in two states, namely, an extended state in which the fastener extends substantially perpendicular to the track 102, and a folded state in which the fastener 104 is folded and is parallel to the track 102 and is essentially tightly attached to the track 102. According to other optional embodiments, the extended state is the default state of the fastener 104. In other words, the fastener 104 tends to extend independently from the track 102. When the rail 110 is free, i.e., when it is not inside the endoscope 60, the fastener 104 is extended. As a result, the fastener 104 assumes a folded state when forced to do so, for example, when the rail 110 is present inside the endoscope 60. Any mechanism that allows the state of the fastener to change between the extended state and the folded state is within the scope of the present subject matter. Some exemplary mechanisms include that the fastener 104 is pivotally attached to the track 102, and that the track 102 and the fastener 104 are made of a material having shape memory designed such that the default state of the fastener 104 is the extended state. Another mechanism is, as follows, one that uses a string 106.

[0165] Still referring to FIG. 32, the fasteners of the rail 110 that extend on the same side of the track 104 are connected by at least one string 106. As seen in FIG. 32, the fasteners 104 that extend towards the inner circle of the rail 110 or towards the raised tissue 520 surrounded by the rail 110 are connected by the string 106, and the fasteners 104 that extend outwards from this circle or away from the raised tissue 520 are also connected by the string 106. However, it should be noted that according to some other embodiments, only the fasteners 104 that extend towards the raised tissue 520 are connected by the string 106, or only the fasteners 104 that extend away from the raised tissue 520 are connected by the string 106.

[0166] According to one embodiment, the string 106 passes through the endoscope 60 and can be operated by the user or an operator of the rail 110. In other words, pushing and pulling the string 106 is performed by the user or an operator of the rail 110. For example, the string 106 can be pulled to fold the fastener 104 from the extended state to the folded state, or can be pushed to unfold the fastener 104 from the folded state to the extended state. The string 106 is also useful in embodiments where the fastener 104 has shape memory in the extended state. In this embodiment, the string 106 can be pulled to forcibly fold the extended fastener 104, or the string 106 can be loosened to allow the fastener 104 to return to its default extended state.

[0167] According to one embodiment, the rail 110 generally has three states, namely, a receiving state in which the rail 110 is inside the endoscope 60 and the shape of the rail 110 is defined by the shape of the endoscope 60, a deployed state in which the rail 110 exits the endoscope 60 and takes a default substantially circular folded state, thereby surrounding the raised tissue, and an operating state in which the raised tissue 520 is treated by a tool attached to the transport means 120 moving along the rail 110. When the tool is the cutting tool 300, the rail 110 is gradually pulled back into the endoscope 60, thereby reducing the diameter of the circle of the rail 110, and a completed state after the raised tissue 520 has been treated, in which the entire rail 110 is pulled back into the endoscope 60 and forced to take a shape similar to that of the endoscope 60. The completed state essentially returns the rail 110 to the receiving state.

[0168] The following are some improvements of the tool.

[0169] Next, referring to FIG. 33, which schematically shows a side view of a tool with a wrapper, FIG. 33 illustrates a rail 110 having a track 102 and a fastener 104 as described above, a transport means 120 moving along or on the rail 110, and a tool attached to the transport means 120, such as a cutting tool 300. In FIG. 33, the cutting tool 300 cuts a raised tissue 520 surrounded by the rail 110. In an experiment conducted using the cutting tool 300 without any additional components, during cutting, the raised tissue tends to collapse onto the cutting tool 300, thus blocking the movement of the transport means 120 carrying the cutting tool 300 and blocking the insertion of the cutting tool 300 into the incised raised tissue 520 for further cutting of the raised tissue 520. Further, when the cutting tool 300 does not have sufficient rigidity, it has been found to cause the cutting tool 300 to bend. A wrapper 310 that at least partially wraps the cutting tool 300 overcomes the aforementioned problems.

[0170] According to one embodiment, the cutting tool 300 comprises a wrapper 310 that at least partially wraps the cutting tool 300. According to another embodiment, the wrapper 310 is configured to support the cutting tool 300 and prevent bending of the cutting tool 300. According to yet another embodiment, the wrapper 310 is configured to remove the collapsing tissue 520 from the cutting tool 300, thus enabling the cutting tool 300 to freely cut the raised tissue 520 and also enabling unobstructed movement of the transport means 120 carrying the cutting tool 300 along the rail 110.

[0171] According to one embodiment illustrated in FIG. 33, the wrapper 310 is made of a plurality of ribs 3102 disposed around at least a portion of the cutting tool 300, and when there is a gap between adjacent ribs 3102, the plurality of ribs 3102 are arranged parallel to the cutting tool 300. According to another embodiment, the wrapper 310 is a complete cylinder that at least partially wraps the cutting tool 300.

[0172] According to one embodiment, the wrapper 310 has a width 310-W. According to another embodiment, the width 310-W of the wrapper 310 is large enough to efficiently remove the collapsed raised tissue 520 from the cutting tool 300. For example, the width 310-W of the wrapper 310 is approximately 1.5 mm.

[0173] According to one embodiment, as seen in FIG. 33, the edge of the wrapper 310 in contact with the collapsed raised tissue 520 is straight. The edge of the wrapper 310 may have any other shape, for example, a rounded shape, but from the viewpoint of efficiently removing the collapsed raised tissue 520 from the cutting tool 300, a straight edge shape is preferred.

[0174] Next, referring to FIG. 34, which schematically shows an upper view of a cutting tool with a dynamic tissue removal tool according to one exemplary embodiment. Another means for removing the collapsed raised tissue 520 from the cutting tool 300 is by using the dynamic tissue removal tool 340 illustrated in FIG. 34. According to one embodiment, the dynamic tissue removal tool 340 includes a slider 342 attached to the cutting tool 300 and configured to slide along the cutting tool 300, a first arm 344 pivotally attached to one side of the slider 342, and a second arm 346 pivotally attached to the opposite side of the slider 342. FIG. 34 illustrates two states of the dynamic tissue removal tool 340. The dynamic tissue removal tool 340 depicted in white is in the rest state 340-R, and the dynamic tissue removal tool 340 depicted in black is in the pushed-in state 340-P. In the rest state 340-R, the slider 342 is located far from the edge 300-E of the cutting tool 300, and the first arm 344 and the second arm 346 are pulled away from the raised tissue 520 cut by the cutting tool 300. In the rest state 340-R, no tissue is removed from the cutting tool 300. To move the dynamic tissue removal tool 340 to the pushed-in state 340-P, the slider 342 is pushed towards the edge 300-E of the cutting tool 300. As a result, the first arm 344 and the second arm 366 are pushed towards the raised tissue 520, thereby removing the raised tissue 520 from the edge 300-E of the cutting tool 300, enabling unobstructed cutting of the raised tissue 520 and free movement of the transport means 120 carrying the cutting tool 300.

[0175] According to one embodiment, the dynamic tissue removal tool 340 additionally includes an elastic member 348, such as a spring 348, that defaults to one of the states of the dynamic tissue removal tool 340. According to one embodiment, the spring 348 defaults to the rest state 340-R. According to another embodiment, the spring 348 defaults to the pushed-in state 340-P. When the dynamic tissue removal tool 340 is released when it is in a corresponding non-default state, the dynamic tissue removal tool 340 automatically returns to the default state.

[0176] A system is provided that enables controlled access of a tool to all sides of a raised tissue in a patient's body. The system includes a rail configured to surround the raised tissue, and at least one transport means configured to carry at least one tool that moves along the rail and is configured to treat the raised tissue and includes The rail includes a track and a plurality of fasteners extending from the track.

[0177] According to one embodiment, the patient is an animal.

[0178] According to one embodiment, the animal is a vertebrate.

[0179] According to one embodiment, the animal is a human.

[0180] A system is also provided that enables controlled access of a cutting tool to all sides of a raised tissue in a patient's body. The system includes a rail configured to surround the raised tissue, and at least one transport means configured to carry at least one cutting tool that moves along the rail and includes a blade configured to cut the raised tissue and includes

[0181] According to one embodiment, the patient is an animal.

[0182] According to one embodiment, the animal is a vertebrate.

[0183] According to one embodiment, the animal is a human.

[0184] According to one embodiment, the cutting tool includes a wrapper that at least partially wraps the cutting tool.

[0185] According to one embodiment, the wrapper is made of a plurality of ribs disposed around at least a portion of the cutting tool, and when there is a gap between adjacent ribs, the plurality of ribs are disposed parallel to the cutting tool.

[0186] According to one embodiment, the wrapper is a complete cylinder that at least partially wraps the cutting tool.

[0187] According to one embodiment, the cutting tool comprises a dynamic tissue removal tool.

[0188] As described herein with reference to the accompanying drawings, a system is additionally provided that enables controlled access of the tool to all sides of the raised tissue in a patient's body.

[0189] It is understood that certain features of the subject matter, which are described in the context of separate embodiments for clarity, may be provided in combination in a single embodiment. Conversely, various features of the subject matter, which are described in the context of a single embodiment for brevity, may be provided separately or in any suitable partial combination.

[0190] Although the subject matter has been described in relation to its specific embodiments, it will be apparent to those skilled in the art that many alternatives, modifications, and variations will be apparent. Therefore, it is intended to embrace all such alternatives, modifications, and variations that fall within the spirit and broad scope of the appended claims.

Claims

1. A shovel attached to the distal edge of an endoscope and configured to protrude from the lower part of the distal edge.

2. The shovel according to claim 1, having a substantially concave structure.

3. The shovel according to claim 1, further comprising a connector configured to connect the shovel to the distal edge of the endoscope.

4. The shovel according to claim 1, further comprising a shovel rail extending along the width of the shovel and substantially perpendicular to the length of the endoscope, wherein the shovel rail is configured to allow a transport means to move along the shovel rail, and thus allow the transport means to move along the width of the shovel.

5. The shovel according to claim 1, further comprising a shovel cover having a cover element configured to cover the shovel from above and to allow the tool to protrude out of the shovel.

6. The shovel cover is provided with an opening on the anterior side of the distal edge of the endoscope, the opening being configured to allow the tool to protrude through it, according to claim 5.

7. The shovel cover permanently covers the shovel, according to claim 5.

8. The shovel cover is removable, according to claim 5.

9. The shovel according to claim 5, wherein a cover connector is attached to the shovel cover and configured to connect the shovel cover to the distal edge of the endoscope.

10. The shovel according to claim 9, wherein the cover connector is in the form of a sleeve that engages with the distal edge of the endoscope.

11. The shovel according to claim 9, wherein the cover connector is configured to be permanently connected to the distal edge.

12. The shovel according to claim 9, wherein the cover connector is configured to be removably connected to the distal edge.

13. The shovel according to claim 5, wherein the cover element is at least partially foldable.

14. The excavator according to claim 4, wherein the excavator is axially attached to the connector by a horizontal shaft located at the bottom of the connector, and the horizontal shaft enables the excavator to rotate upward or downward, or upward and downward.

15. The shovel according to claim 4, wherein the shovel is axially attached to the connector by a vertical axis located at the boundary between the shovel and the connector, and the vertical axis allows the shovel to rotate to the right, to the left, or both to the right and to the left.

16. The shovel according to claim 4, further comprising a swivel sub-shovel (403) positioned above or below the shovel and configured to swivel laterally, thereby enabling an extension of the width of the shovel.

17. The shovel according to claim 1, further comprising a multi-body cutting tool, wherein the multi-body cutting tool comprises a plurality of bodies arranged on the shovel.

18. The shovel according to claim 1, further comprising a lifting element configured to lift a target tissue, wherein the lifting element is configured to be in an upward state and a downward state.

19. The shovel according to claim 18, wherein the lifting element comprises a tissue engaging element configured to engage with the target tissue when lifting the target tissue.

20. The shovel according to claim 19, wherein the tissue engagement element has a high coefficient of friction that enables firm engagement of the tissue engagement element with the target tissue and prevents the target tissue from slipping away from the tissue engagement element during the lifting of the target tissue.

21. The shovel according to claim 1, further comprising a suction lifting element configured to engage with target tissue by suction force and to lift or move the engaged target tissue laterally, wherein the suction lifting element has a nozzle-like structure.

22. The shovel according to claim 21, wherein the suction lifting element comprises a tissue suction element located at the distal end of the nozzle-like structure of the suction lifting element, the suction lifting element is hollow, the tissue suction element is an opening at the distal end of the suction lifting element, the tissue suction element is configured to engage with the target tissue, and then a suction action in the suction lifting element results in the formation of a vacuum force in the tissue suction element, causing the target tissue to be held by the suction lifting element.

23. The shovel according to claim 21, wherein the suction lifting element further comprises at least one protrusion on the upper side of the suction lifting element, or on the bottom side of the suction lifting element, or on both the upper and bottom sides of the suction lifting element, the at least one protrusion enabling engagement with the target tissue.

24. An endoscope comprising a shovel according to claims 1 to 23 attached to the distal edge of the endoscope.

25. The endoscope according to claim 24, further comprising a gripping device attached to the distal edge of the endoscope, wherein the gripping device is configured to grasp target tissue in the vicinity of the shovel.

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