A ureteroscope device and system having a selectively extendable distal portion.

Abstract

An exemplary ureteroscope system 10 is described that includes a handpiece 110 and a catheter 104. The handpiece has a distal end region 114, a proximal end region 112, an interior region 155, and a working channel port 118. The catheter extends from the distal end region of the handpiece. The catheter includes a working channel 152 in fluid communication with the working channel port, a proximal portion proximal to the handpiece, and a distal portion 140 distal to the handpiece that is selectively extendable to an extended position relative to the proximal portion and selectively retractable to a retracted position relative to the proximal portion. The distal portion includes a distal end that defines a working channel opening in fluid communication with the working channel.

Description

[Background technology]

[0001] Small-sized endoscopes are desirable in many industrial and medical applications. For example, when natural openings and lumens in the human body are small, small endoscopes are used for insertion through such openings and lumens to target locations within the body. In the case of single-port laparoscopy, especially when the incision itself is of minimal size, smaller endoscopes are preferred to provide internal images of the surgical site. Patients may sometimes experience irritation when an endoscope is inserted into the body, and smaller endoscopes may alleviate this unpleasant experience and minimize trauma to the patient. Furthermore, physicians may improve diagnostic and procedural protocols with smaller endoscopes. For example, transnasal endoscopes are sometimes used instead of oral endoscopes. [Prior art documents] [Patent documents]

[0002] [Patent Document 1] US Patent Application Publication No. 2022 / 053995 [Patent Document 2] U.S. Patent No. 1,112,9519 [Patent Document 3] US Patent Application Publication No. 2018 / 0140177 [Patent Document 4] U.S. Patent No. 9,942,452 Summary of the Invention [Means for solving the problem]

[0003] Embodiments disclosed herein relate to ureteroscope systems and methods of operating a ureteroscope. In one embodiment, the ureteroscope system includes a handpiece and a catheter. The handpiece has a distal end region, a proximal end region, an interior region, and a working channel port. The catheter extends from the distal end region of the handpiece. The catheter includes a working channel in fluid communication with the working channel port, a proximal portion proximal to the handpiece, and a distal portion distal to the handpiece, the distal portion being selectively extendable to an extended position relative to the proximal portion and selectively retractable to a retracted position. The distal portion includes a distal end defining a working channel opening in fluid communication with the working channel.

[0004] In one embodiment, a method of operating a ureteroscope catheter in a subject is described. The method includes inserting the ureteroscope catheter into the urethra of the subject to a selected position. The method also includes selectively extending a distal portion of the catheter from a retracted position to an extended position using a control member.

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

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

[0007] [Figure 1A] 1 illustrates a ureteroscope as part of an endoscopy system having a catheter with an extendable distal portion in a retracted configuration, according to one embodiment. [Figure 1B] 1B shows an end view of the distal end of the catheter of the ureteroscope of FIG. 1A, according to one embodiment. [Figure 1C]1B illustrates a ureteroscope of the endoscopic system of FIG. 1A with an extendable distal portion in an extended configuration, according to one embodiment. [Figure 2] FIG. 1B is a side view of the handpiece of the ureteroscope of FIG. 1A with a side of the handpiece removed, according to one embodiment. [Figure 3] FIG. 1 is a side view of a ureteroscope handpiece with a side of the handpiece removed, according to one embodiment. [Figure 4] FIG. 1 is a side view of a ureteroscope handpiece with a side of the handpiece removed, according to one embodiment. [Figure 5] 1 is a flowchart of a method of operating a ureteroscope system, according to one embodiment. DETAILED DESCRIPTION OF THE INVENTION

[0008]

[0003] Embodiments disclosed herein relate to devices, systems, and methods for using endoscopes, such as ureteroscopes. At least one, some, or all of the embodiments of the ureteroscope systems and methods described herein include a catheter having a selectively extendable distal portion. For example, at least one, some, or all of the embodiments of the ureteroscope systems and methods described herein include a catheter having an actuated or tensioned distal portion. The extendable (e.g., linearly deforming) distal portion of the ureteroscope catheter according to at least one, some, or all of the embodiments described herein produces the technical effect of enabling an operator to reach the lower pole calyx of a subject's kidney (e.g., a stone in the lower pole), especially under large deflections of the catheter.

[0009] At least one, some, or all embodiments of the ureteroscope systems described herein include a hydrophilic coating on at least a portion (e.g., the distal portion) of the catheter. The hydrophilic coating on at least a portion of the catheter, particularly the distal portion of the catheter, produces the technical effect of reducing the chance of injury (e.g., ureteral abrasion) and / or pain from the catheter to the subject as the distal portion translates or extends forward. The hydrophilic coating produces the technical effect of facilitating easier insertion and / or movement of the catheter within the subject's anatomy. In some embodiments, at least a portion of the catheter may be dipped in a hydrophilic material to coat at least a portion of the catheter with the hydrophilic material (e.g., a Carbopol coating).

[0010] In some embodiments, the ureteroscope can include a small plastic gripper that extends over at least some of the catheter. The gripper produces the technical effect of allowing the healthcare provider to advance the catheter without having to touch the hydrophilic coating of the catheter. The gripper can be left in place once the catheter has been advanced to the desired location, or it can have a slit that allows the healthcare provider to remove the gripper after insertion.

[0011] FIG. 1A illustrates an endoscopic system 10. In one embodiment, the endoscopic system 10 includes a digital ureteroscope 100 operably coupled to one or more electronic devices, such as a host machine 170, and one or more external terminals, including a display 190 and a computer 180. The ureteroscope 100 may be operably coupled to one or more of the host machine 170, the computer 180, or the display 190 wirelessly or through a cable 102. The ureteroscope 100 includes a catheter 104 and a handpiece 110 having a catheter end 114 (e.g., a distal end region) and a control end 112 (e.g., a proximal end region) opposite the catheter end 114. Because the control end 112 is opposite the catheter end 114, the control end 112 and the catheter end 114 may be at different ends of the handpiece 110 and face in different directions relative to each other. In one embodiment, both the catheter 104 and the handpiece 110 are disposable. In some embodiments, the catheter 104 and handpiece 110 are manufactured as a single unit, or the catheter 104 is secured to the handpiece 110 by a handpiece-to-catheter connector 103. Alternatively, only the catheter 104 is disposable, and the handpiece 110 can be sterilized and reused multiple times. In this case, the catheter 104 is removably connected to the handpiece 110 and catheter end 114 by the handpiece-to-catheter connector 103.

[0012] The catheter 104 of the ureteroscope 100 can be used to image the interior surfaces of tubular structures, such as lumens in a human or animal body. For example, the catheter can be inserted through a subject's urethra to access various portions of the urinary tract. The ureteroscope 100 can also be used for imaging, examination, and / or treatment within other organs of the body, such as the kidneys. As indicated above, at least one, some, or all of the embodiments of the ureteroscope 100 described herein provide the technical effect of resulting in improved treatment of the renal calyx. However, it should be appreciated that the ureteroscope 100 can be used as an industrial endoscope when the tubular structure is part of an industrial device, equipment, product, machine, production line, etc. In some embodiments, the catheter 104 can include multiple scale markings or fiducials that allow a physician to measure the distance traveled by the optoelectronic module into the tubular structure, such as a body lumen.

[0013] Other structures may be incorporated into the ureteroscope 100 as needed. For example, the handpiece 110 may include a steering control 124 configured to control one or more steering wires 158 ( FIG. 2 ) connected to the active bending portion 106 of the catheter 104 to deflect the distal end 105 to a desired position. Thus, a user may bend or curve the catheter 102 by moving the steering control 124 on the handpiece 110. In some embodiments, a wire wheel 125 is rotatably secured to the interior region 155 of the handpiece 110. The steering control 124 on the handpiece 110 may be directly or indirectly connected to the wire wheel 124 and configured to selectively rotate the wire wheel 125 at least partially in two different directions. The one or more steering wires 158 are secured to the active bending portion 106 of the catheter 105 and are adjustable in response to rotation of the wire wheel effective to at least partially bend the active bending portion 106 in one or more (e.g., at least two) directions. In some embodiments, the active bending section 106 of the catheter 104 is formed from a flexible medical-grade polymer material to provide maneuverability for the catheter 104 and reduce discomfort to the patient. The catheter 104 may include an active bending section 106 and a passive bending section 101. The active bending section 106 may be generally distal to the handpiece 110 and may be controlled by one or more (e.g., two) control wires 158 (e.g., steel wires) to bend in two directions, one direction being used to bend the active bending section 106 in one direction between 0° and approximately 275°, and the other direction being used to bend the active bending section 106 in the opposite direction through the same angle range. Other numbers of steering wires (e.g., 1, 3, or 4) may also be implemented herein. In contrast, the passive bending section 101 may be located between the active bending section 106 and the handpiece 110 and may bend according to the shape of the urinary tract during insertion.Suitable active bending portions of catheters are disclosed in U.S. Pat. No. 11,129,519 and U.S. Patent Application No. 2018 / 0140177, the disclosures of which are incorporated herein by reference in their entireties.

[0014] In at least one, some, or all embodiments of the ureteroscope 100, the catheter 104 has a selectively extendable and / or retractable distal portion 140 (seen in FIG. 1C ). The distal portion 140 is selectively adjustable to extend from a retracted configuration (e.g., the retracted position shown in FIG. 1A ) to an extended configuration (e.g., the extended position shown in FIG. 1C ). In some embodiments, the distal portion 140 is also selectively adjustable to retract from the extended configuration to the retracted configuration. The extendable (e.g., linearly deforming) distal portion 140 of the catheter 104 of the ureteroscope 100 according to at least one, some, or all embodiments described herein produces the technical effect of enabling an operator to reach the inferior calyx of a subject's kidney (e.g., a stone in the inferior calyx), particularly under large deflections of the catheter 104. In some embodiments, the catheter 104 includes a proximal portion (e.g., at least some of the passive bending portion 101) proximal to the handpiece 110.

[0015] 1C , the distal portion 140 of the catheter 104 is distal to the hand piece 110 and may extend from a region of the catheter 104 generally distal to the hand piece 110. In some embodiments, the distal portion 140 of the catheter extends from an end region of the active bending portion 106 such that, when the distal portion 104 is extended, the active bending portion 106 is disposed between the distal portion 140 and the passive bending portion 101 of the catheter 104. This configuration of the catheter 104 produces the technical effect of allowing an operator to bend the end of the catheter 104 in a desired direction and, if necessary, linearly extend the distal end 105 of the catheter 104 in order to position the distal end 105 of the catheter 104 closer to a target or area requiring treatment or viewing (e.g., the calyx of a kidney). In some embodiments, the distal portion 140 is configured to linearly extend (e.g., lengthen the catheter 104 overall or extend relative to the retracted configuration) a distance X from the active bending portion 106 of about 2 mm to about 30 mm, about 2 mm to about 15 mm, about 15 mm to about 30 mm, about 2 mm to about 10 mm, about 10 mm to about 20 mm, about 20 mm to about 30 mm, about 2 mm to about 5 mm, about 5 mm to about 10 mm, about 10 mm to about 15 mm, about 15 mm to about 20 mm, about 20 mm to about 25 mm, or about 25 mm to about 30 mm. In some embodiments, the operator of the ureteroscope 100 can selectively extend the distal portion 140 a preferred or selected distance X based on the situation in use. For example, the distal portion 140 can be configured to selectively extend (or lengthen the catheter 104 overall) from the active bending portion 106 to a selected position within any of the ranges provided above.

[0016] Ureteroscope 100, according to one embodiment, includes an actuator and control member configured to enable an operator of the ureteroscope to selectively extend and / or retract distal portion 140. For example, with reference to FIG. 2 , ureteroscope 100 may include an actuator 160 disposed in an interior region 155 of handpiece 110, operably connected to distal portion 140, and configured to at least extend and / or retract distal portion 140 of catheter 104 relative to a proximal portion of catheter 104. More specifically, actuator 160 may include a base member 164 and one or more wires 162 or cables secured to the base and distal portion 140 of catheter 104. Base member 160 may be positioned in interior region 155 of handpiece 110 and may be selectively movable (e.g., linearly) in interior region 155 between a first position and a second position. When the base is in the first position, the distal portion 140 of the catheter 104 may be tensioned by one or more wires 162, which holds the distal portion in a retracted position when the base member 164 is in the first position. Moving the base member 162 to a second position in the interior region 155 of the handpiece 162 may extend the distal portion 140 to an extended position.

[0017] The distal portion 140 is operably coupled to the actuator 160 such that the distal portion 140 selectively extends and / or retracts in response to the actuator 160. For example, in some embodiments, the distal portion 140 of the catheter 104 includes a coil spring 142 or bellows at least partially housed within the distal portion 140 and having a distal end region secured directly or indirectly to one or more wires or cables 162. In some embodiments, the distal end may include any of a variety of springs or other biasing members, such as a compression spring, an extension spring, a coil spring, a torsion spring, a spring belt, a leaf spring, and / or a compliant piece of material. In some embodiments, the distal portion 140 includes a wall or end piece proximal to the distal end 105 to which one or more wires 162 or cables are secured, retaining the coil spring 142 or bellows to the distal portion 140. In some embodiments, the wall or end piece can have an optoelectronic module 109 and / or a light source 111 embedded in the wall or end piece or secured to the opposite side of the coil spring 142. The distal portion can be held in a retracted position when one or more cables 162 hold the coil spring 142 or bellows in at least partial tension. Moving the base member 164 to a second position in the interior region 155 of the handpiece 110 can at least partially release the tension in the coil spring 142 or bellows, causing the coil spring to uncoil and linearly force the distal end 105 outward, extending the distal portion 140 to the extended configuration. Returning the base member 164 to the first position in the interior region 155 of the handpiece 110 applies tension to one or more wires 162 or cables, pulling the coil spring 142 or bellows inward toward the handpiece 110, thereby linearly shortening the coil spring 142 or bellows and returning the distal portion 140 to an at least partially retracted configuration. In some embodiments, the distal end 140 may include a mating distal end that extends and / or retracts relative to the actuator 160, and the coil spring 142 may not be present.

[0018] In some embodiments, the ureteroscope 100 includes a control member 121 operably connected to the actuator 160 for selectively extending and / or retracting a distal portion of the catheter 104 relative to a proximal portion of the catheter 104. For example, the control member 121 may include a sliding tab, grip, or button secured to a base member 164 on the exterior of the handpiece. In some embodiments, the base member includes a rigid arm extending from the sliding tab, grip, or button to an interior region 155 of the handpiece. The handpiece 110 may include an elongated slot that allows the sliding tab, grip, or button to slide from a first position corresponding to the first position of the base member 164 to a second position corresponding to the second position of the base member 164. In some embodiments, the handpiece 110 includes one or more locking elements between the first and second positions of the sliding tab, grip, or button, allowing the operator to lock the sliding tab, grip, or button at a selected position between the first and second positions of the sliding tab, grip, or button, thereby retaining the distal portion in a selected partially extended configuration. The locking elements may include additional vertical slots or frictional locking elements. In some embodiments (not shown), the control member 121 is separate from the handpiece 110. For example, the control member 121 may include electronics that are separate or distinct from the handpiece but operably connected to the communication interface 150 and / or the base 164.

[0019] The ureteroscope 100 may include an optoelectronic module (e.g., a camera or other imaging device) for imaging the interior of a subject. For example, with reference to FIG. 1B , an optoelectronic module 109 (e.g., an image sensor) and at least one light source 111 may be disposed at the distal end 105 of the catheter 104 or at another location in the catheter 104. The optoelectronic module 109 may include a micro-camera module having an image sensor microchip, a set of microlenses, and a micro-illumination module. A suitable optoelectronic module is disclosed in U.S. Pat. No. 9,942,452, the entire contents of which are incorporated herein by reference. In some embodiments, the optoelectronic module 109 may be positioned in a rigid or semi-rigid shell-like housing at the distal end 105 configured for insertion into a tubular structure to image the interior surface. For example, the optoelectronic module 109 may be inserted into a patient's body through a natural body orifice, such as the mouth, nose, urethra, bladder, vagina, or anus. Thus, ureteroscope 100 may have different configurations for use as a gastrointestinal, colonoscope, endoscopic ultrasound (EUS), endoscopic retrograde cholangiopancreatography (ERCP), or other suitable application. Applications for ureteroscope 100 include diagnostic observations related to endometrial polyps, infertility, abnormal bleeding, and pelvic pain, and surgical procedures such as embryonic growth arrest and uterine malformations.

[0020] The ureteroscope 100 may include a receiving device or communication interface 150 (FIG. 2), generally disposed outside the catheter 104, for receiving signals from an image sensor in the optoelectronic module 109. For example, the catheter 104 may include at least one electrical lead 162 (FIG. 2) coupled to the optoelectronic module 109 and transmitting electrical signals from the optoelectronic module 109 to the communication interface 150. The communication interface 150 may be positioned within an interior region 155 (FIG. 2) of the handpiece 110 or adjacent to the handpiece 110.

[0021] The catheter 104 may be configured to couple the optoelectronic module 109 to the circuitry within the handpiece 110 in any suitable manner. For example, the availability of low-cost modular imaging system components allows for the manufacture of disposable components for the ureteroscope 100 at very low cost. In one embodiment, the catheter 104 is configured to removably couple the optoelectronic module 109 to the circuitry within the handpiece 110. In this manner, the catheter 104 and optoelectronic module 109 are disposable and may be removed from the handpiece 110 after a single patient use, thereby eliminating the need for sterilization or reprocessing and reducing the risk of contamination. The handpiece 110 may be sterilized for later reuse with the catheter 104 and optoelectronic module 109 for a different patient.

[0022] Returning to FIG. 1A , endoscopic system 10 may include one or more electronic devices for processing and displaying image data received from optoelectronic module 109 of ureteroscope 100. For example, endoscopic system 10 may include one or more of a host machine 170 having a microprocessor, a computer 180 having a microprocessor, and a display 190. Host machine 170 may be connected to one or more terminals of computer 180 and display 190 for further processing and display of image data from optoelectronic module 109. Host machine 170 or computer 180 may be programmed with image processing software. The image processing software receives as input the image data output from optoelectronic module 109 of ureteroscope 100 and generates a two-dimensional or three-dimensional reconstruction of the body lumen, which may be displayed on display 190. Thus, a processor in at least one of host machine 170, computer 180, or display 190 may be programmed with software that receives as input multiple still images of the object generated by optoelectronic module 109 and then outputs for display a three-dimensional rendering of the object based on the multiple still images. Display 190 may include any suitable display and may be configured to display moving images (e.g., a movie or video) or still images collected by the image sensor of optoelectronic module 109. Although shown as separate blocks in FIG. 1A , host machine 170, computer 180, and display 190 may comprise one device, two devices, three devices, or four or more devices.

[0023] The endoscopic system may also include a cable 102 configured to operably couple the ureteroscope to at least one of a host machine 170, a computer 180, a display 190, and / or other electronic devices (such as a remote control member 121). The cable 102 may electrically couple the retrieval device 150 ( FIG. 2 ) of the ureteroscope 100 to at least one of the host machine 170, the computer 180, or the display 190. The cable 102 may also enable the communication interface 150 to communicate with and receive power from the host machine 170 or other power source. The cable 102 may also be configured to enable image data captured in the optoelectronic module 109 to be transmitted to the host machine 170 for processing, storage, and display.

[0024] Referring to FIG. 2 , which shows a side view of the handpiece 110 along with a portion of the handpiece 110, the ureteroscope 100 may include a communications interface 150 or a host interface housed within the handpiece 110. The communications interface 150 may include, for example, one or more of a processor board, a camera board and frame grabber, or a power supply. The processor board may be coupled by a cable 102 to a host machine 170 for storage and retrieval of images generated by the ureteroscope 100. The communications interface 150 may also be configured to communicate with and receive power from the host machine 170 or other power source via the cable 102. The communications interface 150 may transmit image data captured at the distal end 105 to the host machine 170 for processing, storage, and display. The communications interface 150 may be connected to the cable 102 by one or more wires 154 and / or to the optoelectronic module 109 by one or more electrical leads 162.

[0025] Alternatively or additionally, communication interface 150 or handpiece 110 may include an antenna and a wireless chipset, e.g., compliant with the IEEE 802.11 Wi-Fi standard, for wirelessly transmitting video or still images generated by ureteroscope 100 to host machine 170, computer 180, or display 190 without a cable 102. For example, communication interface 150 may include a wireless interface configured to implement various protocols, including, but not limited to, Wi-Fi, Bluetooth®, ZigBee®, Z-Wave, etc. This arrangement may be useful in a physician's office because it allows the computer and display to be located outside the sterile field while also allowing the physician greater maneuverability during use of ureteroscope 100. In other embodiments, communication interface 150 may be omitted, and image data may be transmitted directly to host machine 170 and / or computer 180.

[0026] Ureteroscope 100 can be operated to perform or complete selected tasks manually, automatically, or a combination thereof. Some ureteroscope functions can be implemented through the use of components including hardware, software, firmware, or a combination thereof. While general-purpose components such as a general-purpose computer or oscilloscope can be used in ureteroscope 100, dedicated or custom components such as circuits, integrated circuits, or software can also be used. For example, some functions are implemented by software executed by one or more data processors that are part of a general-purpose or custom computer. The one or more data processors can be in at least one of communications interface 150, host machine 170, computer 180, or display 190. In some embodiments, the data processor or computer includes volatile memory for storing instructions and / or data and / or non-volatile storage, such as a magnetic hard disk and / or removable media, for storing instructions and / or data. In some embodiments, the implementation includes a network connection. In some embodiments, the implementation includes a user interface, generally including one or more input devices (e.g., allowing for input of instructions and / or parameters) and output devices (e.g., allowing for reporting of operation parameters and results).

[0027] The handpiece 110 also includes a working channel port 118 and a working channel opening 107 ( FIG. 1B ), which provides fluid communication between the working channel port 118 and the distal end 105 of the catheter 104. The handpiece 110 may also include a working channel connector 130 connected to or attached to the working channel port 118, and a working channel 152 that provides fluid communication between the working channel port 118 and the working channel opening 107 through the handpiece 110 and / or catheter 104. The working channel 152 may extend through the distal portion 140 to include the working channel opening 107 at the distal end 105 of the catheter 104. The working channel 152 may comprise one continuous material through the handpiece 110 and the catheter 104. In some embodiments, the working channel 152 includes a first portion in an interior region 155 of the handpiece 110 and a second portion in the catheter 104. The first and second portions of the catheter 152 may comprise different materials or configurations fluidly connected to one another. At least one of the working channel port 118 or the working channel connector 130 is configured to engage various surgical instruments and irrigation devices, such as laser fibers, as needed, for operations such as stone fragmentation and retrieval. The working channel port 118 may be positioned proximal to the catheter end 114 of the handpiece 110, at the lower / bottom or upper / top of the handpiece 110. The working channel port 118 may be positioned less than half the distance from the catheter end 114 to the control end 112, less than one-third the distance from the catheter end 114 to the control end 112, less than one-quarter the distance from the catheter end 114 to the control end 112, or less than one-fifth the distance from the catheter end 114 to the control end 112.

[0028] The handpiece 110 may also include a cable port 120 for accepting or connecting a cable 102 (FIG. 1A) to operably couple the ureteroscope 100 to at least one of a host machine 170, a computer 180, or a display 190. The cable port 120 and the working channel port 118 may also be positioned on a lower or bottom portion of the handpiece 110, proximal to the catheter end 114 of the handpiece 110. For example, both the cable port 120 and the working channel port 118 may be positioned less than half the distance from the catheter end 114 to the control end 112, less than one-third the distance from the catheter end 114 to the control end 112, less than one-quarter the distance from the catheter end 114 to the control end 112, or less than one-fifth the distance from the catheter end 114 to the control end 112. Alternatively, the handpiece may further include a compact battery module for powering the optoelectronic module 109 and the at least one light source 111. The power source in handpiece 110 can be, for example, one or more conventional disposable dry cell batteries or a lithium-ion rechargeable battery.

[0029] 1 and 2 includes a cable port 120 positioned proximal to the catheter end 114 and distal to the control end 112, in some embodiments, the cable port 120 is omitted from the handpiece 110 or is positioned proximal to the control end 112 and distal to the catheter end 114. Accordingly, in some embodiments, the cable port 120 is omitted from the handpiece 110 or is positioned proximal to the control end 112. Furthermore, while the ureteroscope 100 shown in FIGS. 1 and 2 includes a working channel port 118 positioned on a rounded first surface 126 along a longitudinal midplane proximal to the catheter end 114 and distal to the control end 112, in some embodiments, the working channel port 118 may be positioned elsewhere in the handpiece 110. Accordingly, in some embodiments, the working channel port 118 may be positioned other than along the longitudinal midplane proximal to the catheter end 114.

[0030] In at least one, some, or all embodiments of the ureteroscope 100, at least a portion of the catheter 104 may be a catheter with a slippery coating, such as a hydrophilic coating, disposed thereon. For example, at least the distal portion 140 may include a hydrophilic coating. In some embodiments, at least one (e.g., both) of the distal portion 140 and / or the active bending portion 106 includes a hydrophilic coating disposed thereon. In some embodiments, the entire catheter 104, including the distal portion 140 and the active bending portion 106, includes a hydrophilic coating disposed thereon. The hydrophilic coating on the catheter 104 produces the technical effect of allowing easier insertion of the catheter 104 into a subject and less ureteral trauma / tear during insertion. The hydrophilic coating may include a carbopol or polyvinylpyrrolidine (PVP) coating.

[0031] 3, in some embodiments, the actuator 360 of the ureteroscope 300 may include a motor 364 positioned in the interior region 155 of the handpiece 110. Unless otherwise stated, the ureteroscope 300 may include any aspect of the ureteroscope 100, including the catheter 104, the active bending portion 106, the selectively extendable and / or retractable distal portion 140, the coil spring 142, one or more wires or cables 162, the optoelectronic module 109, and / or the light source 111. FIG. 3 is a side view of the handpiece 110 of the ureteroscope 300 with the side of the handpiece 110 removed, according to one embodiment.

[0032] The motor 364 may be operably connected to the distal portion 140 and may be configured to extend or retract the distal portion 140 of the catheter 104 relative to the proximal portion of the catheter 104. For example, one or more wires 162 or cables may be fixed to the motor 364 and the distal portion 140 of the catheter 104. The motor 364 may be configured to increase (e.g., unwind or release) the amount of one or more wires 162 or cables between the motor 364 and the distal portion 140 of the catheter 104 to extend the distal portion 140 to the extended position. The motor 364 may also be configured to decrease (e.g., wind or retract) the amount of one or more wires 162 or cables between the motor 364 and the distal portion 140 of the catheter 104 to retract the distal portion 140 to the retracted position. The distal portion 140 may be held in the retracted position when the one or more cables 162 hold the coil spring 142 in at least a partial tensioned state. When the motor 364 increases (e.g., unwinds or releases) the amount of one or more wires 162 or cables between the motor 364 and the distal portion 140 of the catheter 104, the tension in the coil spring 142 may be at least partially released, causing the coil spring to expand and linearly push the distal end 105 outward, extending the distal portion 140 to the extended configuration. When the motor 364 decreases (e.g., winds or retracts) the amount of one or more wires 162 or cables between the motor 364 and the distal portion 140 of the catheter 104, the tension in the one or more wires 162 or cables may pull the coil spring inward toward the handpiece 110, causing the coil spring 142 to linearly shorten and move the distal portion 140 at least partially back toward the retracted configuration.

[0033] In some embodiments, the distal portion 140 fits at least partially into the catheter in the retracted position. In some embodiments, the motor 364 is positioned in the handpiece 140 proximal to the catheter 104, and one or more wires 162 or cables are not present. Instead, the catheter 104 may include an outer tube secured to the handpiece 110 and an inner tube secured to the motor 364 and comprising the distal end 105 of the catheter. The inner tube may be slidable or movable within the outer tube, and the inner tube may be secured to the motor 364, which may push, force, or direct a portion of the inner tube out from the distal end of the outer tube, thereby linearly extending the catheter 104. The motor 364 may pull or retract the inner tube to retract the inner tube back into the outer tube, thereby linearly retracting the catheter 104.

[0034] In some embodiments, the ureteroscope 300 includes a control member 321 operably connected to the actuator 360 for selectively extending and / or retracting the distal portion 140 of the catheter 104 relative to the proximal portion of the catheter 104. For example, the control member 321 may include a button, a sliding tab, or a grip on the outside of the handpiece 110 and operably coupled to the motor 364. In some embodiments (not shown), the control member 321 is separate from the handpiece 110. For example, the control member 321 may include electronics that are separate or separate from the handpiece 110 but operably connected to the communication interface 150 and / or the motor 364.

[0035] 4, in some embodiments, the actuator of the ureteroscope 400 may include a pneumatic or hydraulic pump 460 positioned in an interior region of the housing 1110. Unless otherwise stated, the ureteroscope 400 may include any aspect of the ureteroscope 100, including the catheter 104, the active bending section 106, the optoelectronic module 109, and / or the light source 111. FIG. 4 is a side view of the handpiece 110 of the ureteroscope 400 with the side of the handpiece 110 removed, according to one embodiment.

[0036] The catheter 104 of the ureteroscope 400 also includes a selectively extendable and / or retractable distal portion 440. A pump 460 may be positioned in the handpiece at least proximally (e.g., adjacent) to the catheter 104. The pump 460 may selectively pneumatically or hydraulically increase pressure in at least a portion of the catheter 104 effective to deform at least the distal portion 440 of the catheter 104 to extend the distal portion 440 of the catheter 104 to the extended position. The pump 460 may also selectively pneumatically or hydraulically decrease pressure in at least a portion of the catheter 104 effective to deform at least the distal portion 440 of the catheter 104 to retract the distal portion 440 of the catheter 104 to the retracted position. For example, the distal portion 440 may include a bellows that extends with increased pressure from the pump 460 and retracts when pressure is no longer applied by the pump 460.

[0037] In some embodiments, the ureteroscope 400 includes a control member 421 operably connected to the pump 460 to selectively extend and / or retract the distal portion 440 of the catheter 104 relative to the proximal portion of the catheter 104. For example, the control member 440 may include a button, a sliding tab, or a grip on the outside of the handpiece 110 and operably coupled to the pump 460. In some embodiments (not shown), the control member 421 is separate from the handpiece 110. For example, the control member 421 may include electronics that are separate or separate from the handpiece 110 but operably connected to the communication interface 150 and / or the pump 460.

[0038] 5 is a flow diagram of a method 500 for operating a ureteroscope catheter in a subject, according to one embodiment. Method 500 may include an act 510 of inserting the ureteroscope catheter into the subject's urethra to a selected position. Method 500 may also include an act 520 of selectively extending a distal portion of the catheter from a retracted position to an extended position using a control member.

[0039] In some embodiments, act 520 may include actuating, by a control member, an actuator disposed in an interior region of the hand piece and operably connected to the distal portion to extend the distal portion of the catheter relative to the proximal portion of the catheter. More specifically, actuating, by a control member, an actuator disposed in an interior region of the hand piece and operably connected to the distal portion to extend the distal portion of the catheter relative to the proximal portion of the catheter may include moving a base of the actuator positioned in the interior region of the hand piece from a first position to a second position to at least partially release tension on one or more wires or cables secured to the base and the distal portion of the catheter. The distal portion of the catheter may include a coil spring or bellows at least partially housed in the distal portion and having a distal end region secured to the one or more wires or cables, whereby moving the base of the actuator from the first position to the second position at least partially releases tension on the one or more wires or cables and the coil spring in the distal portion. In some embodiments, actuating by the control member an actuator disposed in an interior region of the hand piece and operably connected to the distal portion to extend the distal portion of the catheter relative to the proximal portion of the catheter can include actuating a motor positioned in the interior region of the hand piece to increase the amount of one or more wires or cables between the motor and the distal portion of the catheter to extend the distal portion to the extended position. In some embodiments, actuating by the control member an actuator disposed in an interior region of the hand piece and operably connected to the distal portion of the catheter to pneumatically or hydraulically increase pressure in at least a portion of the catheter and deform at least the distal portion of the catheter to extend the distal portion of the catheter to the extended position.

[0040] In some embodiments of method 500, when the distal portion is selectively extended, the distal portion is withdrawn from the catheter, the control member may include a selectively slidable tab on the handpiece, the control member includes an electronic device separate from the handpiece, and / or at least the distal portion of the catheter includes a hydrophilic coating on at least the distal portion of the catheter. In some embodiments, method 500 also includes bending an active bending portion of the catheter before selectively extending the distal portion of the catheter. In some embodiments, selectively extending the distal portion of the catheter includes selectively extending the distal portion of the catheter by between about 2 mm and about 30 mm.

[0041] The acts of method 500 described above, including but not limited to acts 510 and 520, are for illustrative purposes. For example, the acts of method 500 may be performed in a different order, divided into multiple acts, modified, supplemented, or combined. In one embodiment, one or more of the acts of method 500 may be omitted from method 500. Any of the acts of method 500 may include using any of the handpiece 110, ureteroscopes 100, 300, 400, and / or systems 10 disclosed herein.

[0042] As used herein, the terms "about" or "substantially" refer to an acceptable variation of the term modified by "about" or "substantially" of ±10% or ±5%. Furthermore, the terms "less than," "equal to or less than," "greater than," "more than," or "equal to or greater than" include, as endpoints, the value modified by the term "less than," "equal to or less than," "greater than," "more than," or "equal to or greater than."

[0043] While various aspects and embodiments have been disclosed herein, other aspects and embodiments are contemplated, and the embodiments disclosed herein are for purposes of illustration and are not intended to be limiting.

Claims

1. 1. A ureteroscope system, comprising: a handpiece having a distal end region, a proximal end region, an interior region, and a working channel port; a catheter extending from the distal end region of the handpiece, the catheter including a working channel in fluid communication with the working channel port, a proximal portion proximal to the handpiece, and a distal portion distal to the handpiece, the distal portion selectively extendable to an extended position and selectively retractable to a retracted position relative to the proximal portion, the distal portion including a distal end defining a working channel opening in fluid communication with the working channel; A ureteroscope system comprising:

2. 10. The ureteroscope system of claim 1, an actuator disposed in the interior region of the handpiece, operably connected to the distal portion, and configured to extend and retract the distal portion of the catheter relative to the proximal portion of the catheter; a control member operably connected to the actuator for selectively extending and retracting the distal portion of the catheter relative to the proximal portion of the catheter; The ureteroscope system further comprises:

3. 3. The ureteroscope system according to claim 2, wherein the actuator comprises: a base positioned in the interior region of the handpiece and movable within the interior region between a first position and a second position; one or more wires or cables secured to the base and the distal portion of the catheter; Including, a distal portion of the catheter being tensioned by the one or more wires when the base is in the first position, such that the distal portion is held in the retracted position when the base is in the first position, and moving the base to the second position extends the distal portion to the extended position.

4. 4. The ureteroscope system of claim 3, wherein the distal portion of the catheter includes a coil spring at least partially housed within the distal portion and having a distal end region secured to the one or more wires or cables, such that when the base is in the first position, the coil spring is held in a tensioned state while the distal portion is held in the retracted position, and moving the base to the second position at least partially releases the tension in the coil spring and extends the distal portion to the extended position.

5. 3. The ureteroscope system of claim 2, wherein the actuator includes a motor positioned in the interior region of the handpiece, operably connected to the distal portion, and configured to extend and retract the distal portion of the catheter relative to the proximal portion of the catheter.

6. 6. The ureteroscope system of claim 5, further comprising one or more wires or cables fixed to the motor and the distal portion of the catheter, wherein the motor is configured to increase the amount of the one or more wires or cables between the motor and the distal portion of the catheter to extend the distal portion to the extended position, and to decrease the amount of the one or more wires or cables between the motor and the distal portion of the catheter to retract the distal portion to the retracted position.

7. 7. The ureteroscope system of claim 6, wherein the distal portion of the catheter includes a coil spring at least partially housed within the distal portion and having a distal end region secured to the one or more wires or cables, whereby increasing the amount of the one or more wires or cables between the motor and the distal portion of the catheter extends the distal portion to the extended position, and decreasing the amount of the one or more wires or cables between the motor and the distal portion of the catheter retracts the distal portion to the retracted position.

8. 3. The ureteroscope system of claim 2, wherein the actuator includes a pneumatic or hydraulic pump positioned in the interior region of the housing, the pneumatic or hydraulic pump comprising: pneumatically or hydraulically increasing pressure in at least a portion of the catheter effective to deform at least the distal portion of the catheter to extend the distal portion of the catheter to the extended position; pneumatically or hydraulically reducing pressure in at least a portion of the catheter effective to deform at least the distal portion of the catheter to retract the distal portion of the catheter to the retracted position; A ureteroscope system configured to:

9. 9. The ureteroscope system of claim 2, wherein the distal portion fits at least partially within the catheter in the retracted position.

10. 10. The ureteroscope system of claim 2, wherein the control member includes a selectively slidable tab on the handpiece.

11. 10. The ureteroscope system of claim 2, wherein the control member includes an electronic device separate from the handpiece.

12. 12. A ureteroscope system according to any one of claims 1 to 11, the proximal portion of the catheter includes an active bending section distal to the handpiece and proximal to the distal portion of the catheter; a wire wheel secured to the interior region of the handpiece; a steering control device connected to the wire wheel and configured to at least partially rotate the wire wheel in two different directions; one or more wires secured to the active bending portion of the catheter and adjustable in response to rotation of the wire wheel effective to at least partially bend the active bending portion; The ureteroscope system further comprises:

13. 13. A ureteroscope system according to any one of claims 1 to 12, wherein the distal portion is configured to extend from about 2 mm to about 30 mm in the extended position relative to the retracted position of the distal portion.

14. 14. The ureteroscope system of any one of claims 1 to 13, further comprising a hydrophilic coating on at least the distal portion of the catheter.

15. 1. A method of actuating a ureteroscope catheter in a subject, comprising: inserting a ureteroscope catheter into the subject's urethra to a selected location; and selectively extending a distal portion of the catheter from a retracted position to an extended position using a control member.

16. 16. The method of claim 15, wherein selectively extending a distal portion of the catheter from a retracted position to an extended position using a control member includes actuating, by the control member, an actuator disposed in the interior region of the handpiece and operably connected to the distal portion to extend the distal portion of the catheter relative to the proximal portion of the catheter.

17. 17. The method of claim 16, wherein actuating by the control member an actuator disposed in the interior region of the hand piece and operably connected to the distal portion of the catheter to extend the distal portion of the catheter relative to the proximal portion of the catheter comprises moving a base of the actuator positioned in the interior region of the hand piece from a first position to a second position to at least partially release tension in one or more wires or cables secured to the base and the distal portion of the catheter.

18. 18. The method of claim 17, wherein the distal portion of the catheter includes a coil spring at least partially housed within the distal portion and having a distal end region secured to the one or more wires or cables, whereby moving the base of the actuator from the first position to the second position at least partially releases tension in the one or more wires or cables and the coil spring in the distal portion.

19. 17. The method of claim 16, wherein actuating by the control member an actuator disposed in the interior region of the handpiece and operably connected to the distal portion of the catheter to extend the distal portion relative to the proximal portion of the catheter comprises actuating a motor positioned in the interior region of the handpiece to increase the amount of one or more wires or cables between the motor and the distal portion of the catheter to extend the distal portion to the extended position.

20. 17. The method of claim 16, wherein actuating by the control member an actuator disposed in the interior region of the handpiece and operably connected to a distal portion of the catheter to extend the distal portion of the catheter relative to the proximal portion of the catheter comprises actuating a pneumatic or hydraulic pump positioned in the interior region of the housing to pneumatically or hydraulically increase pressure in at least a portion of the catheter and deform at least the distal portion of the catheter to extend the distal portion of the catheter to the extended position.

21. 21. The method of any one of claims 15 to 20, wherein when the distal portion is selectively extended, the distal portion is pushed out of the catheter.

22. 22. The method of any one of claims 15 to 21, wherein the control member comprises a selectively slidable tab on the handpiece.

23. 22. The method of any one of claims 15 to 21, wherein the control member includes an electronic device separate from the handpiece.

24. 24. The method of any one of claims 15 to 23, further comprising bending an active bending portion of the catheter before selectively extending the distal portion of the catheter.

25. 25. The method of any one of claims 15 to 24, wherein selectively extending the distal portion of the catheter comprises selectively extending the distal portion of the catheter by between about 2 mm and about 30 mm.

26. 26. The method of any one of claims 15 to 25, wherein at least a distal portion of the catheter includes a hydrophilic coating at least in the distal portion of the catheter.

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