Medical Device Components, Assemblies, and Related Methods

Abstract

The elevator of the medical device may include a plurality of segments joined to one another by at least one hinge and a control element coupled to at least one of the plurality of segments, wherein a first segment of the plurality of segments may be a separate structure, and wherein proximal or distal movement of the control element may be configured to move at least one of the plurality of segments relative to another of the plurality of segments.

Description

[Technical Field]

[0001] Various aspects of the present disclosure relate generally to medical device components, assemblies, and related methods. In particular, aspects of the present disclosure relate to, among other aspects, elevators for duodenoscopes. [Background technology]

[0002] A duodenoscope may include a handle and a sheath, which may be insertable into a body lumen of a subject. The sheath may terminate in a distal tip portion. The distal tip portion may include features such as optical elements (e.g., camera, lighting), air and water outlets, and a working channel opening. An elevator may be located at the distal tip and may be operable to change the orientation of a medical device / tool ​​passed through the working channel. For example, the elevator may be swingable or otherwise movable.

[0003] Elements in the handle may control elements at the distal tip. For example, a button, knob, lever, etc. may control the elements at the distal tip. The elevator may be controlled via a control mechanism in the handle, such as a lever, which may be attached to a control wire that couples to the elevator. When an actuator (e.g., a lever) is actuated, the wire may move proximally and / or distally, thereby raising and / or lowering the elevator. Summary of the Invention

[0004] Each of the embodiments disclosed herein may include one or more of the features described in connection with any of the other disclosed embodiments. In one example, an elevator for a medical device can include a plurality of segments joined to one another by at least one hinge and a control element coupled to at least one of the plurality of segments. A first segment of the plurality of segments can be a separate structure. Proximal or distal movement of the control element can be configured to move at least one of the plurality of segments relative to another of the plurality of segments.

[0005] Any of the devices disclosed herein may additionally or alternatively include any of the following features, in any combination: All of the plurality of segments may be separate structures. The plurality of segments may consist of a first segment and a second segment. In the first configuration, all of the plurality of segments may lie along a substantially straight line. The substantially straight line may be substantially parallel to a longitudinal axis of the medical device. The control element may be a first control element, and the elevator may further include a second control element coupled to at least one of the plurality of segments. Proximal or distal movement of the second control element may be configured to move at least one of the plurality of segments relative to another of the plurality of segments. Each of the plurality of segments may define a first channel for receiving the first control element. Each of the plurality of segments may define a second channel for receiving the second control element. The first control element may be coupled to a first actuator of a handle of the medical device. The second control element may be coupled to a second actuator of a handle of the medical device. The first actuator may be actuable separately from the second actuator. The most distal segment of the plurality of segments may include a socket on an outer surface of the most distal segment. The socket may be configured to receive a distal end of a control element. The first segment may include a first distal surface. The second segment of the plurality of segments may include a first proximal surface and a second distal surface. The third segment of the plurality of segments may include a second proximal surface. The first distal surface of the first segment and the first proximal surface of the second segment may be separated by a first angle. The second distal surface of the second segment and the second proximal surface of the third segment may be separated by a second angle. The second angle may be different from the first angle. Each segment of the plurality of segments may include a base wall, a first sidewall, and a second sidewall. The first sidewall of each segment may define a channel configured to receive the control element. The width of the first side wall of each segment may be greater than the width of the second side wall of each segment.The at least one hinge may include a pin or a rivet.The distal-most segment of the plurality of segments may include a protrusion extending distally. The control element may be fixed to the protrusion. The proximal-most segment of the plurality of segments may include a shaft configured to be rotatably coupled to the distal tip of the medical device. At least one of the plurality of segments may be configured to rotate relative to the proximal-most segment of the plurality of segments during distal movement of the control element before the proximal-most segment of the plurality of segments rotates relative to the distal tip of the medical device.

[0006] In another example, an elevator of a medical device may include a plurality of segments joined to one another by at least one hinge, a first control element coupled to at least one of the plurality of segments, and a second control element coupled to at least one of the plurality of segments, wherein proximal or distal movement of the first control element may be configured to move at least one of the plurality of segments relative to another of the plurality of segments, and proximal or distal movement of the second control element may be configured to move at least one of the plurality of segments relative to another of the plurality of segments.

[0007] Any of the devices described herein may additionally or alternatively include any of the following features, in any combination: At least two of the plurality of segments are monolithically formed with one another; Each of the plurality of segments may define a first channel for receiving a first control element; Each of the plurality of segments may define a second channel for receiving a second control element.

[0008] In another example, an elevator of a medical device may include a first segment, a second segment, a third segment, a first hinge between the first and second segments, and a second hinge between the second and third segments, where the first segment may include a first distal surface, the second segment may include a first proximal surface and a second distal surface, the third segment may include a second proximal surface, the first distal surface of the first segment and the first proximal surface of the second segment may be separated by a first angle, and the second distal surface of the second segment and the second proximal surface of the third segment may be separated by a second angle, where the second angle may be different from the first angle.

[0009] Any of the devices described herein may additionally or alternatively include any of the following features, in any combination: The first segment, the second segment, and the third segment may be monolithically formed with one another.

[0010] It will be understood that both the foregoing general description and the following Detailed Description are exemplary and explanatory only and are not limiting of the invention, as claimed. As used herein, the terms "comprises / consists," "comprising / consisting of," or any other variation thereof, are intended to cover a non-exclusive inclusion, such that a process, method, article, or device that includes a list of elements does not comprise only those elements, but may include other elements not expressly listed or inherent to such process, method, article, or device. The term "diameter" may refer to the width when an element is not circular. The term "distal" refers to the direction away from the operator, and the term "proximal" refers to the direction toward the operator. The term "exemplary" is used in the sense of "example," not "ideal." The term "approximately" or similar terms (e.g., "substantially") include values ​​of ±10% of the stated value.

[0011] The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate aspects of the disclosure and, together with the description, serve to explain the principles of the disclosure. [Brief explanation of the drawings]

[0012] [Figure 1A] 1 illustrates an exemplary medical device. [Figure 1B] 1 illustrates an exemplary medical device. [Figure 2A] FIG. 1C illustrates an exemplary elevator that may be used with the exemplary medical device of FIGS. 1A-1B. [Figure 2B] FIG. 1C illustrates an exemplary elevator that may be used with the exemplary medical device of FIGS. 1A-1B. [Figure 2C] FIG. 1C illustrates an exemplary elevator that may be used with the exemplary medical device of FIGS. 1A-1B. [Figure 3A] FIG. 1 illustrates another exemplary elevator. [Figure 3B] FIG. 1 illustrates another exemplary elevator. [Figure 3C] FIG. 1 illustrates another exemplary elevator. [Figure 4] 2A to 3C. FIG. [Figure 5] 2A to 3C. FIG. [Figure 6] FIG. 1 illustrates another exemplary elevator. [Figure 7A] 1A-1C illustrate exemplary elevators in various configurations. [Figure 7B] 1A-1C illustrate exemplary elevators in various configurations. [Figure 7C] 1A-1C illustrate exemplary elevators in various configurations. [Figure 7D] 1A-1C illustrate exemplary elevators in various configurations. [Figure 7E] 1A-1C illustrate exemplary elevators in various configurations. [Figure 8A] 1 illustrates a further exemplary elevator. [Figure 8B] 1 illustrates a further exemplary elevator. [Figure 9A] FIG. 1 illustrates another exemplary elevator. [Figure 9B] FIG. 1 illustrates another exemplary elevator. [Figure 9C] FIG. 1 illustrates another exemplary elevator. [Figure 10A] 1 illustrates a further exemplary elevator. [Figure 10B] 1 illustrates a further exemplary elevator. [Figure 10C] 1 illustrates a further exemplary elevator. DETAILED DESCRIPTION OF THE INVENTION

[0013] A duodenoscope or other medical device (e.g., an endoscopic ultrasound (EUS) scope) may include a distal tip having an elevator. The elevator may be operably connected to an actuator in the handle of the duodenoscope. When an operator activates the actuator, the elevator may be raised or lowered. The elevator may originally be in a lowered configuration when the operator inserts an accessory device (e.g., a guidewire instrument) into the working channel of the duodenoscope and advances the instrument through the working channel. After the accessory device is extended out the distal opening of the working channel, the elevator may be raised to deflect the distal tip of the instrument. For example, such deflection may be utilized to allow the operator to access a subject's bile duct and / or cannulate a subject's major papilla.

[0014] A conventional rigid elevator with a scoop-shaped guide surface can deflect an instrument into a lowered and an elevated configuration. In other words, such an elevator can partially articulate / deflect an accessory device even in a fully open / lowered configuration. Such a rigid scoop-shaped elevator can also allow for limited articulation options (e.g., exclusively in the fully open / lowered position or exclusively in the fully closed / elevated position). A segmented elevator can allow the elevator to lie completely flat (e.g., lying approximately parallel to the longitudinal axis of the distal tip of the duodenoscope) when in the open / down position. A completely flattened elevator can allow the accessory device to extend straight from the distal surface of the duodenoscope (e.g., approximately parallel to the central longitudinal axis of the distal tip of the duodenoscope). A segmented elevator can also or alternatively facilitate incremental deflection of the accessory device. The operator may have additional control over the accessory because the operator can incrementally articulate the elevator segment by segment to facilitate access to anatomical structures (e.g., the bile duct and pancreatic duct). The segmented elevator may allow the operator to deflect the accessory at multiple different angles laterally from the central longitudinal axis of the duodenoscope and maintain the deflected position.

[0015] FIG. 1A shows an exemplary duodenoscope 10 having a handle 12 and an insertion portion 14. FIG. 1B shows the proximal end of the handle 12. The duodenoscope 10 may also include an umbilicus 16 for connecting the duodenoscope 10 to sources of, for example, air, water, suction, power, etc., as well as imaging and / or viewing equipment. While reference may be made herein to a duodenoscope, it will be understood that the present disclosure also encompasses endoscopes, bronchoscopes, gastroscopes, EUS scopes, colonoscopes, ureteroscopes, bronchoscopes, laparoscopes, cystoscopes, suction scopes, sheaths, catheters, or similar devices. Reference herein to a duodenoscope should be understood to encompass any of the above medical devices.

[0016] The insertion portion 14 may include a sheath or shaft 18 and a distal tip 20. The distal tip 20 may include an imaging device 22 (e.g., a camera) and an illumination source 24 (e.g., an LED or optical fiber). The distal tip 20 may be oriented laterally. That is, the imaging device 22 and illumination source 24 may be oriented radially outward, perpendicularly, approximately perpendicularly, or otherwise laterally relative to the longitudinal axis of the shaft 18 and distal tip 20. Additionally or alternatively, the distal tip 20 may include one or more imaging devices 22 oriented in more than one direction. For example, a first imaging device 22 may be oriented radially outward, and a second imaging device 22 may be oriented distally (approximately parallel to the longitudinal axis of the distal tip 20 / shaft 18).

[0017] The distal tip 20 may also include an elevator 26 for changing the orientation of a tool inserted into the working channel of the duodenoscope 10. The elevator 26 may alternatively be referred to as a swing table, a rocking table, a lifting table, or any other suitable terminology. The elevator 26 may be swingable, for example, via an actuation wire or another control element extending from the handle 12 through the shaft 14 to the elevator 26.

[0018] The distal portion of the shaft 18, which is connected to the distal tip 20, may have a steering section 28. The steering section 28 may be, for example, an articulation joint. The shaft 18 and steering section 28 may include a variety of structures that are or may become known in the art.

[0019] The handle 12 may have one or more actuator / control mechanisms 30. The control mechanisms 30 may provide control over the steering section 28 or may allow for the provision of air, water, suction, etc. For example, the handle 12 may include control knobs 32, 34 for left, right, up, and / or down control of the steering section 28. For example, one of the knobs 32, 34 may provide left / right control of the steering section 28, and the other of the knobs 32, 34 may provide up / down control of the steering section 28. The handle 12 may further include one or more locking mechanisms 36 (e.g., knobs or levers) for preventing steering and / or braking of the steering section 28 in at least one of the up, down, left, or right directions. The handle 12 may include an elevator control lever 38 (see FIG. 1B ). Elevator control lever 38 may raise and / or lower elevator 26 via a connection between lever 38 and an actuation wire extending from lever 38 through shaft 18 to elevator 26. Port 40 may allow tools to pass through port 40 into the working channel of duodenoscope 10, through sheath 18 and to distal tip 20.

[0020] In use, an operator can insert at least a portion of the shaft 18 into a body lumen of a subject. The distal tip 20 can be navigated to a treatment site within the body lumen. The operator can insert an accessory device (not shown) into the port 40 and route the accessory device through the shaft 18, through the working channel, and into the distal tip 20. The accessory device can exit the working channel at the distal tip 20. The user can use the elevator control lever 38 to raise the elevator 26 and angle the accessory device toward a desired location (e.g., the papilla of the pancreaticobiliary duct). The user can use the accessory device to perform a medical procedure.

[0021] 2A-10C illustrate exemplary elevators and their features. While features may be described herein with reference to specific examples, it will be understood that the features described herein may be combined in any suitable combination. The elevators of FIGS. 2A-10C may include multiple segments such that the elevator is flexible along its length (i.e., along the longitudinal direction of the disclosed elevator). Any of the elevators described herein may be used with duodenoscope 10 or another medical device and may have any of the mechanisms of elevator 26. For convenience, reference will be made below to features of duodenoscope 10, but this should not be understood as limiting the features of the elevators described herein.

[0022] 2A-2C illustrate a first exemplary elevator 100. FIG. 2A illustrates a perspective view of the elevator 100. FIG. 2B illustrates a side view of the elevator 100, and FIG. 2C illustrates a view of the elevator 100 looking proximally. The elevator 100 may include a first proximal segment 102 and a second distal segment 104 (only the distal segment 104 is visible in FIG. 2C). The elevator 100 may include exactly two segments 102, 104. Arrows "P" and "D" in FIG. 2A indicate the proximal and distal directions. In FIG. 2C, the distal direction extends out from the page, and the proximal direction extends into the page. The first segment 102 and the second segment 104 may be joined by a hinge 110. The proximal end of the first segment 102 (i.e., the most proximal segment of the elevator 100) may include a shaft 120. A control element 130 may be coupled to the second segment 104.

[0023] The first segment 102 and the second segment 104 may be joined by a hinge 110. The hinge 110 may include, for example, a living hinge. In an example, the first segment 102 and the second segment 104 may be formed from a single monolithic piece of material, such as a flexible piece of material. For example, the hinge 110 and / or other portions of the elevator 100 may include plastic or metal. The elevator 100 / hinge 110 material may be flexible and may not have a shape memory mechanism. Additionally or alternatively, the hinge 110 may be overmolded to form a living hinge or may include other attachment means with plastic or metal wire. In such a configuration, the first segment 102 and the second segment 104 may be formed from separate pieces of material (not monolithically formed) or may be monolithically formed with additional components overmolded / attached. Elevator 100, including its segments and hinges, may comprise any suitable material, such as metal or plastic, and may be formed by any suitable manufacturing method, including additive or subtractive manufacturing methods, such as molding, three-dimensional printing, engraving, or other methods.

[0024] The hinge 110 may have a height (in the direction "A" shown in FIG. 2B , perpendicular to the proximal / distal direction) that is smaller than the first segment 102 and the second segment 104. In other words, the elevator 100 may have a hinge 110 that is thinner than the first segment 102 or the second segment 104. The elevator 100 may optionally include a recess in the hinge 110 (e.g., one or more of the first segment 102 or the second segment 104 may include a recess). In this manner, the elevator 100 may be flexible at the hinge 110. Accordingly, as described in further detail below with respect to FIG. 4 , the second segment 104 may be able to articulate (rotate / swing) relative to the first segment 102 about the hinge 110.

[0025] The distal surface 112 of the first segment 102 and the proximal surface 114 of the second segment 104 may be tapered such that the elevator 100 includes a notch that defines the hinge 110. The notch may have a generally V-shape. As particularly shown in FIG. 2B , the notch may have a flat V-shape, with the hinge 110 defining the flat surface of the V-shape. For example, the distal surface 112 of the first segment 102 may taper such that the height of the first segment 102 decreases distally along the extent of the distal surface 112. The proximal surface 114 of the second segment 104 may taper such that the height of the second segment 104 increases distally along the extent of the proximal surface 114. The hinge 110 may extend between the distal surface 112 and the proximal surface 114. For example, the hinge 110 may include a thin strip of material. Hinge 110 may additionally or alternatively include any known or becoming known characteristics of a living hinge. When elevator 100 bends about hinge 110 (as described in further detail below), proximal surface 114 of second segment 104 may contact / abut / mate with distal surface 112 of first segment 102. Thus, proximal surface 114 and distal surface 112 may define the limits / range of articulation / bending of hinge 110 (i.e., bending may be limited by the interaction of proximal surface 114 and distal surface 112, and the articulated profile of elevator 100 may be defined, at least in part, by the interaction between proximal surface 114 and distal surface 112). In some examples, the first segment 102 may include a pair of distal surfaces 112, 113 (one on each side of the first segment 102), and the second segment 104 may include a pair of proximal surfaces (one on each side of the second segment 104) 114, 115. The distal surface 112 may have substantially the same shape as the distal surface 113, the proximal surface 114 may have substantially the same shape as the proximal surface 115, and the proximal surface 115 may be configured to abut the distal surface 113 when the proximal surface 114 abuts the distal surface 112.

[0026] The shaft 120 may be disposed at the proximal end of the first segment 102. In some examples, the shaft 120 may be monolithically formed with the first segment 102. The shaft 120 may have a circular cross-section, as shown in FIG. 2B. As shown in FIGS. 2A and 2C, the shaft 120 may extend beyond the first segment 102 along direction B (perpendicular to direction A and the proximal / distal direction) on both sides of the first segment 102. In alternative examples, the shaft 120 may extend beyond the first segment 102 along direction B on only one side of the first segment 102. Or, the shaft 120 may not extend beyond the first segment 102 along direction B. The shaft 120 may be configured to interact with a feature of the distal tip 20 such that the elevator 100 is rotatable relative to other components of the distal tip 20. For example, the distal tip 20 may include a complementary feature for receiving the shaft 120. The shaft 120 may be rotatable along an axis generally parallel to direction B. Alternatively, it may be substantially immovable relative to the distal tip 20.

[0027] The control element 130 may be coupled to the second segment 104. The control element 130 may include, for example, a wire, cable, rod, chain, string, cord, or other suitable structure. For example, as shown in FIGS. 2A-2C , the control element 130 may include a wire 132 and a protrusion 134 at a distal end of the wire 132. For example, the protrusion 134 may include a ball. Alternatively, the protrusion 134 may have other shapes (e.g., cylindrical, flat like a nailhead, square, rectangular, oval, hemispherical / oval, conical, or any other suitable shape). The protrusion 134 and the wire 132 may be formed from a single monolithic material (i.e., the protrusion 134 may be integrally formed with the wire 132). Or, the protrusion 134 and the wire 132 may comprise separate pieces that are coupled to each other (e.g., via welding, crimping, threaded coupling, adhesive, or other suitable mechanism).

[0028] The second segment 104 may include a socket 136 configured to receive the control element 130 (e.g., the protrusion 134 and / or the wire 132). The socket 136 may protrude from an outer surface of another portion of the elevator 100, such as the outer surface of the second segment 104. In an example, the socket 136 may protrude from one side of the second segment 104 along direction B. The location of the socket 136 shown in FIGS. 2A-2C is merely exemplary. The socket 136 may be located, for example, on the opposite side of the elevator 100 (e.g., the opposite side of the segment 104 in direction B). In some examples, the socket 136 may function as a boss. As shown in FIG. 2A in particular, the socket 136 may define a channel 138 for receiving the control element 130, which may have a generally "U" shape. An outer wall 140 of the socket 136 may define an opening 142 for receiving the outer surface of the protrusion 134. An inner wall 144 of the socket 136 can hold the protrusion 134 in a desired location within the channel 138. The protrusion 134 is rotatably coupled to the second segment 104 and cannot move proximally or distally (or along the A or B direction). During assembly, the protrusion 134 can be inserted into the socket 136 along the B direction, and the outer wall 140 of the socket 136 can include one or more passages (not shown, but can be arranged on a distal surface of the outer wall 140, for example) to allow the wires 132 to pass through and be aligned substantially along the longitudinal axis of the elevator 100. Other mechanisms can alternatively be used to hold the protrusion 134 within the socket 136.

[0029] 2A-2C, socket 136 may be located on an exterior surface of elevator 100 (e.g., of second segment 104), and control element 130 may extend outside of first segment 104 and second segment 102 (i.e., not between the walls of elevator 100). In the alternative, control element 130 may extend along the interior of elevator 100 (i.e., between the walls of elevator 100). Control element 130 may alternatively be coupled to elevator 100 by any suitable alternative structure (e.g., a control arm coupled to elevator 100).

[0030] The inner surfaces of first segment 102 and second segment 104, together with the inner surface of hinge 110, may define guide surface 160. An accessory device inserted into the working channel of duodenoscope 110 may extend distally from the distal opening of the working channel and extend onto / along guide surface 160. As described in further detail below, when elevator 100 is raised (e.g., using control element 130), guide surface 160 may contact the accessory device and apply a force to the accessory device to articulate it (e.g., a radially outward force away from the central longitudinal axis of duodenoscope 10). When elevator 100 is lowered, the accessory device may resume a generally straight configuration (i.e., unarticulated).

[0031] The guide surface 160 may have any suitable shape. As best shown in FIG. 2C , along the first segment 102 and the second segment 104, the guide surface 160 may have a generally “U”-shaped cross-section having a central surface 162 (the lower surface in the coordinate system of FIGS. 2B and 2C ) and side surfaces 164 (extending in the up-down direction of FIGS. 2B and 2C ). As shown in FIGS. 2A-2C , the central surface 162 may be generally planar, with the planes of the central surface 162 generally aligned along the proximal / distal direction and the B direction. The side surfaces 164 may also be generally planar, with their planes generally aligned along the A direction and the proximal / distal direction. The central surface 162 and the side surfaces 164 may meet at a curved joint. In the hinge 110, the guide surface 160 may include only the central surface 162 and not the side surfaces 164. During operation, central surface 162 may apply a force to the accessory, causing it to articulate as elevator 100 is raised. Side surfaces 164 may retain the accessory on central surface 162 (i.e., prevent the accessory from sliding off elevator 100). However, guide surfaces 160 may have any suitable shape and are not limited to the configurations described above.

[0032] 2A and 2B, the proximal edge 172 of segment 102 and the distal edge 174 of segment 104 may be tapered. For example, the proximal edge 172 may taper inwardly along the proximal direction. The distal edge 174 may taper inwardly along the distal direction. As shown in FIG. 2B, the taper of the proximal edge 172 may be more gradual than the taper of the distal edge 174. However, such a configuration is merely exemplary, and the proximal edge 172 and the distal edge 174 may have any suitable profile.

[0033] As shown in FIGS. 2A-2C, elevator 100 is in an open configuration (i.e., a lowering configuration, a non-articulating configuration, or a non-rising configuration). In the open configuration, as best shown in FIGS. 2A and 2B, elevator 100 is substantially straight and extends in a proximal / distal direction. In particular, central plane 162 is generally flat between the proximal end of elevator 100 and the distal end of elevator 100 (i.e., in a cross-section of elevator 100 taken along the longitudinal axis of elevator 100, central plane 162 would form a generally straight line from the proximal end of elevator 100 to the distal end of elevator 100). In other words, all of the segments of elevator 100 may extend along a substantially straight line extending parallel to and / or coaxially with the longitudinal axis of elevator 100. In this manner, an accessory device received by elevator 100 (e.g., by guide surface 160) in the open configuration can extend generally parallel to the proximal / distal direction (e.g., generally parallel to the central longitudinal axis of duodenoscope 10). Thus, the accessory device can extend distally from duodenoscope 10 without substantially extending radially outward / inward. Such a configuration can be desirable for performing a medical procedure or some steps of a medical procedure with a forward-facing (i.e., distally-facing) tool. In some examples, duodenoscope 10 can include a forward-facing (i.e., distally-facing) imaging device (e.g., a camera) and / or lighting element for performing such a forward-facing medical procedure or step of a medical procedure. Further details of the closed (i.e., raised, articulated) configuration of elevator 100 are described below (e.g., with respect to FIG. 4).

[0034] 3A-3C, another exemplary elevator 200 may include any of the features of the elevator 100 described above, except as noted herein. Where possible, corresponding reference numbers (i.e., reference numbers including the same second and third digits) are used to refer to corresponding structures. The elevator 200 may include a first proximal segment 202 and a second distal segment 204. The first segment 202 may be a separate, individual piece / structure from the second segment 204. In other words, the first segment 202 and the second segment 204 may not be monolithically formed from one piece of material. Instead, the first segment 202 may be formed from a separate piece of material from the second segment 204, or may be formed from the same piece of material and then separated from each other. The first segment 202 and the second segment 204 may be joined by a hinge 210. For example, one or more pins 211 (FIG. 3B) may extend through portions of the first segment 202 and the second segment 204 to rotatably connect the first segment 202 to the second segment 204. Alternatively, other types of fasteners (e.g., rivets, screws) or other types of hinges may be utilized. The distal end of the first segment 202 and the proximal end of the second segment 204 may be configured to allow the second segment 204 to articulate relative to the first segment 202 (and vice versa). For example, the shapes of the first segment 202 and the second segment 204 may be selected to accommodate such articulation.

[0035] FIG. 4 illustrates elevator 300 (having any of the characteristics of elevators 100, 200) in a partially closed (i.e., articulated or partially raised) configuration. Where possible, corresponding reference numbers (i.e., reference numbers including the same second and third digits) are used to refer to corresponding structure. Elevator 300 may include a first proximal segment 302 and a second distal segment 304 joined by hinge 310. While first segment 302 and second segment 304 are shown as separate elements joined by hinge 310 similar to hinge 210 of FIGS. 3A-3C, it will be understood that hinge 310 may have any of the characteristics of hinge 110 of FIGS. 2A-2C and that first segment 302 and second segment 304 may be integrally formed.

[0036] The shaft 320 may be rotatably coupled to the distal tip 20 such that it is rotatable about an axis extending into and out of the page of FIG. 4 but is otherwise unable to move substantially relative to the distal tip 20. Similarly, the protrusion 334 of the control element 330 may be rotatable relative to the socket 336 but may not otherwise be able to move substantially relative to the socket 336.

[0037] As shown in FIG. 4 , the control element 330 can be moved proximally by an operator (e.g., via the elevator control lever 38 of the duodenoscope 10). As the control element 330 moves proximally, the control element 330 can apply a force to the second segment 304. The control element 330 can rotate / rock the second segment 304 about the hinge 310. In this manner, the second segment 304 can move relative to the first segment 302. When the control element 330 is initially moved proximally, the first segment 302 may not initially rotate about the axis 320. Thus, the first segment 302 can remain positioned substantially along the longitudinal axis of the distal tip 20 (i.e., along the proximal / distal direction as labeled by arrows “P” and “D” in FIG. 4 ).

[0038] As shown in FIG. 4 , articulation of elevator 300 may bring proximal surface 314 of second segment 304 closer to distal surface 312 of first segment 302. For example, proximal surface 314 of second segment 304 may be generally parallel to and / or contact distal surface 312 of first segment 302. The shapes of proximal surface 314 and distal surface 312 (e.g., the angle of taper of proximal surface 314 and distal surface 312) may define an articulation angle of elevator 300, as described in more detail below with respect to FIG. 5 . Alternatively, other structure of elevator 300 (e.g., stops, protrusions, or features of hinge 310) may define the degree to which second segment 304 articulates relative to first segment 302.

[0039] As the control element 330 continues to be moved proximally, the first segment 302 may rotate about the axis 320 (not shown in FIG. 4 ). For example, the first segment 302 may rotate about the axis 320 after the second segment 304 is fully articulated relative to the first segment 302 (e.g., after further bending about the hinge 310 is no longer possible because the distal surface 312 abuts the proximal surface 314). As the first segment 302 rotates about the axis 320, the distal end 303 of the first segment 302 moves upward in FIG. 4 / rotates counterclockwise in FIG. 4 about the axis 320. In other words, as the first segment 302 rotates, the first segment 302 may be oriented transversely relative to the longitudinal axis of the distal tip 20. Features of the elevator 300, the control element 330, the elevator control lever 38, or other features of the duodenoscope 10 may limit the range of rotation of the first segment 302 about the axis 320 and define the range of motion of the elevator 300.

[0040] When elevator 300 is articulated (i.e., opened or closed), an accessory (not shown) may be articulated as described above with respect to FIGS. 2A-2C. In the partially articulated configuration of FIG. 4, the accessory may be articulated such that a distal portion of the accessory has a first angle relative to a more proximal portion of the accessory. In the fully articulated configuration (first segment 302 has rotated about axis 320), the distal portion of the accessory may have a second angle relative to a proximal portion of the accessory. The second angle may be less than the first angle, such that the first angle is more open than the second angle. In other words, the accessory may be articulated / flexed more in the fully closed configuration than in the partially closed configuration of elevator 300.

[0041] With elevator 300 in a partially or fully articulated configuration, an operator may perform a medical procedure, such as cannulating a subject's papilla. In some examples, duodenoscope 10 may include side-facing (i.e., radially outward facing) imaging devices (e.g., cameras) and / or illumination elements for performing such a medical procedure or step of a medical procedure.

[0042] The elevator 300 may be moved in the reverse direction (to move the elevator 300 from the closed position to the open position) by moving the control element 330 distally. The movement may also be performed in the reverse order from that described above, with the elevator 300 first rotating about the axis 320 (assuming the elevator 300 has been previously rotated about the axis 320 to close the elevator 300) until the elevator 300 is flat / fully open, and then the second segment 304 rotates relative to the first segment 302.

[0043] FIG. 5 illustrates elevator 400 (having any of the characteristics of elevators 100, 200, 300) in an open configuration. Where possible, corresponding reference numbers (i.e., reference numbers including the same second and third digits) are used to refer to corresponding structures. Elevator 400 may include a first proximal segment 402 and a second distal segment 404 joined by a hinge 410. While first segment 402 and second segment 404 are shown as being integrally formed with one another and joined by hinge 410 similar to hinge 110 of FIGS. 2A-2C, it will be understood that hinge 410 may have any of the characteristics of hinge 210 of FIGS. 3A-3C, and that first segment 402 and second segment 404 may be separate structures from one another.

[0044] As shown in FIG. 5 , the distal surface 412 of the first segment 402 may taper distally toward the hinge 410, and the proximal surface 414 of the second segment 404 may taper distally toward the hinge 410. FIG. 5 illustrates an axis Y1 that bisects the hinge 410 and extends vertically in FIG. 5 perpendicular to the longitudinal axis of the elevator 400 (i.e., perpendicular to the proximal and distal directions). Each of the distal surface 412 and the proximal surface 414 may have an angle θ (having any suitable value) relative to the axis Y1. The angle θ may be selected based on the desired final profile (e.g., curve) of the elevator 400 and the number of segments of the elevator 400. The angle θ may be selected to generate different accessory angles as viewed through the imaging device 22 when the elevator 400 is locked, for example, an accessory angle configured to position the accessory within the field of view of the imaging device 22. As described above, the angle of the distal surface 412 and the proximal surface 414 can define an articulation angle of the elevator 400. For example, the elevator 400 may be able to bend at an angle of about 2θ (i.e., the second segment 404 may be able to bend at an angle of 2θ relative to the first segment 402) until the distal surface 412 and the proximal surface 414 abut or come close to one another (e.g., as shown in FIG. 4 for the distal surface 312 and the proximal surface 314 of the elevator 300).

[0045] 6A illustrates an alternative elevator 500, which may have any of the characteristics of elevators 100, 200, 300, and 400, except as specified herein. Elevator 500 may include multiple segments 502, 504, 506, 508, and 510. Segments 502, 504, 506, 508, and 510 may have any of the characteristics of any of the segments described above. Segments 502 and 504 may be joined by hinge 522, segments 504 and 506 may be joined by hinge 524, segments 506 and 508 may be joined by hinge 526, and segments 508 and 510 may be joined by hinge 528. Hinges 522, 524, 526, and 528 may have any of the characteristics of the hinges described above. Some or all of segments 502, 504, 506, 508, 510 may be monolithically formed with some or all of hinges 522, 524, 526, 528, including living hinges (e.g., like hinge 110). Additionally or alternatively, some or all of segments 502, 504, 506, 508, 510 may be separately formed structures / pieces, with some or all of hinges 522, 524, 526, 528 joining separate structures (e.g., like hinge 210). A combination of monolithically formed structures and separate segment pieces may be utilized in elevator 500.

[0046] Axes Y2, Y3, Y4, and Y5 are shown in FIG. 6 as extending perpendicular to the longitudinal axis of elevator 500 (i.e., vertically in FIG. 6) through the midpoints of each of hinges 522, 524, 526, and 528. Axes Y2, Y3, Y4, and Y5 may be substantially parallel to one another. Segment 502 may have a distal surface 532a, and segment 504 may have a proximal surface 532b. Segment 504 may have a distal surface 534a, and segment 506 may have a proximal surface 534b. Segment 506 may have a distal surface 536a, and segment 508 may have a proximal surface 536b. Segment 508 may have a distal surface 538a, and segment 510 may have a proximal surface 538b. Surfaces 532a, 532b may be on opposite sides of hinge 522; surfaces 534a, 534b may be on opposite sides of hinge 524; surfaces 536a, 536b may be on opposite sides of hinge 526; and surfaces 538a, 538b may be on opposite sides of hinge 528.

[0047] As described below, the surfaces of segments 502, 504, 506, 508, and 510 may be at various angles relative to axes Y2, Y3, Y4, and Y5. These various angles may provide different articulation profiles for elevator 500. For example, some of segments 502, 504, 506, 508, and 510 may bend at sharper angles relative to one another than other segments 502, 504, 506, 508, and 510. The angle combinations described herein are by way of example only, and any suitable angle combination may be selected to achieve a desired articulation profile for elevator 500.

[0048] The distal surface 532a may have an angle β with respect to the axis Y2. The proximal surface 532b may have an angle φ with respect to the axis Y2. In some examples, the angle β may be different from the angle φ. The angles β and φ may be selected to provide a desired articulation. The distal surface 534a and the proximal surface 534b may each have an angle α with respect to the axis Y3. The distal surface 536a may have an angle α with respect to the axis Y4. In some examples, the angle α may be different from the angles β and φ. The proximal surface 536b may have an angle θ with respect to the axis Y4. The angle θ may be different from the angles α, β, and φ. The distal surface 538a and the proximal surface 538b may each have an angle θ with respect to the axis Y5.

[0049] The above-described arrangements and angles are merely exemplary. The angles of the surfaces around the hinges 522, 524, 526, and 528 can be selected to achieve various articulation profiles. For example, the hinges 522, 524, 526, and 528 can have various angles at which adjacent links are bent relative to one another. Alternatively, the hinges 522, 524, 526, and 528 can each bend at the same angle. In addition to having various angled end faces, the segments 502, 504, 506, 508, and 510 can have the same or different lengths (along the longitudinal axis of the elevator 500, i.e., along the proximal / distal direction). The lengths of the segments 502, 504, 506, 508, and 510 can be selected to impart a desired shape / articulation profile to the elevator 500 when in an articulated (e.g., closed or partially closed) configuration.

[0050] 6B and 6C show elevator 500' having any of the characteristics of elevator 500 except as described herein. The reference numbers of elevator 500' may correspond to the reference numbers of elevator 500 with the suffix "prime" added. Corresponding reference numbers may have corresponding characteristics except as described below.

[0051] As shown in FIG. 6B, distal surface 532a' may have an angle δ relative to axis Y2'. Proximal surface 532b' may have an angle ε relative to axis Y2'. In some examples, angle δ may be different from angle ε. Angles δ and ε may be selected to provide a desired articulation. As shown in FIG. 6C and described with respect to FIGS. 6D-6E below, because angles δ and ε are different from one another (e.g., because angle δ is greater than angle ε), when elevator 500' is articulated, corner 533a of distal surface 532a' may extend slightly above corner 533b of proximal surface 532b' (in the reference frame of FIGS. 6B and 6C). Such a configuration may ensure that elevator 500' does not contact the housing or other portions of distal tip 20 in undesirable locations or may provide other mechanical advantages. The distal surface 534a' and the proximal surface 534b' may each have an angle η with respect to the axis Y3'. The distal surface 536a' and the proximal surface 534b' may each have an angle ε with respect to the axis Y4'. The distal surface 538a' and the proximal surface 538b' may each have an angle ε with respect to the axis Y5'. The angles δ, ε, and η may each be different from one another.

[0052] As shown in FIG. 6C , the relative angles between surfaces of elevator 500′ can define different articulation profiles along elevator 500′. For example, segments 504′ and 506′ may be at a smaller angle relative to each other than segments 506′ and 508′ due to the smaller size of angle η relative to angle ε. In other words, the angle between longitudinal axis M along segment 504′ and longitudinal axis N along segment 506′ may be closer to 180 degrees than the angle between longitudinal axis N and longitudinal axis O along segment 508′. Because the angle between segments 508′ and 510′ is the same as the angle between segments 506′ and 508′, the angle between longitudinal axis O along segment 508′ and longitudinal axis P along segment 510′ may be the same.

[0053] 6D and 6E illustrate another elevator 500″ having any of the characteristics of elevators 500, 500′ except as described herein. The reference number of elevator 500′ may correspond to the reference number of elevator 500 with a double “prime” added to the end of the reference number of elevator 500. Corresponding reference numbers may have corresponding characteristics except as described below. Although elevator 500″ is shown as having only two segments 502″, 504″, it will be understood that elevator 500″ may have any suitable number of segments.

[0054] As shown in FIG. 6D , distal surface 532a″ can be at an angle ψ with respect to axis Y2″. Proximal surface 532b″ can be at an angle λ with respect to axis Y2″. Angle ψ can be different from angle λ. Angles ψ and λ can be selected to provide a desired articulation. As shown in FIG. 6D , in the relaxed configuration, heights H (up and down in FIG. 6D ) of segments 502″ and 504″ can be the same. As shown in FIG. 6E , because angles ψ and λ are different from one another (e.g., because angle λ is greater than angle ψ), when elevator 500″ is articulated, corner 533a′ of distal surface 532a″ can extend above corner 533b′ of proximal surface 532b″ (in the reference frame of FIG. 6E ) such that a step G is formed between corner 533a′ and corner 533b′. Additionally, as shown in FIG. 6E, surfaces 532a'' and 532b'' may not be flush with one another such that a gap is formed between them.

[0055] 7A-7E show elevator 600 in various stages of articulation, including a fully open (i.e., immobilized, raised, or lowered) position in FIG. 7A, a nearly fully closed (i.e., fully mobile or raised) position in FIGS. 7B-7D, and a fully closed position in FIG. 7E. Elevator 600 may have any of the features of elevators 100, 200, 300, 400, and 500 described above and may be used with duodenoscope 10. Reference numbers corresponding to elevator 500 (i.e., reference numbers having the same second and third digits) are used where possible.

[0056] Segments 602, 604, 606, 608, and 610 may be connected via hinges 622, 624, 626, and 628. Segment 602 may be the most proximal segment, and segment 610 may be the most distal segment. While five segments are shown, it will be understood that any suitable number of segments (e.g., two, three, four, six, seven, or more segments) may be utilized. While Figures 7A-7E depict segments 602, 604, 606, 608, and 610 as separate structures / pieces, it will be understood that segments 602, 604, 606, 608, and 610 may alternatively be formed from a single monolithic piece of material. Similarly, although hinges 622, 624, 626, and 628 are shown as including pin 640 (labeled with respect to hinge 622 in FIG. 7A and also present in hinges 624, 626, and 628), it will be understood that hinges 622, 624, 626, and 628 may use any alternative connection structure and / or may include living hinges.

[0057] Each of the segments 602, 604, 606, 608, 610 may have a base wall 652, a first side wall 654, and a second side wall 656 (labeled with respect to segment 610 in FIG. 7A and also present in segments 602, 604, 606, 608). The base wall 652 and the side walls 654, 656 may define a guide surface 658 for contacting and guiding an accessory device. The side walls 654 may each define a channel 660 extending generally parallel to the longitudinal axis of the distal tip 20 of the elevator 600 / duodenoscope 10. A control element (not shown in FIGS. 7A-7E) having any of the characteristics of a control element described above may extend through the channel 660 in each of the side walls 654. The control element may be movable relative to the channel 660. Sidewall 654 may have a greater thickness (along an axis extending between sidewalls 654 and 656 of a given segment) than sidewall 656 to accommodate channel 660 .

[0058] Segment 610 (or any distal-most segment) may include a fixation point 662 for securing a distal tip of a control element to segment 610. For example, the control element may be secured to fixation point 662 via, for example, a friction fit, adhesive, crimping, welding, fasteners, or any other suitable mechanism. Fixation point 662 may be disposed on a protrusion 664 on sidewall 654 of segment 610. Protrusion 664 may protrude distally from another portion of sidewall 654. Segment 610 may be longer in the proximal / distal direction (i.e., along the longitudinal axis of elevator 600) to accommodate protrusion 664. Sidewall 656 of segment 600 (opposite segment 610 from sidewall 654) may have a length corresponding to the length of sidewall 654 of segment 610, including protrusion 664.

[0059] Segment 602 (or any proximal-most segment) may include axle 670. In some examples, axle 670 may be integrally formed with segment 602 from a monolithic piece of material. In other examples, axle 670 may be a separate component secured to segment 602. Axle 670 may have any suitable configuration. For example, base wall 652 of segment 602 may define a notch 672, and axle 670 may extend across the notch. Axle 670 may extend generally perpendicular to the longitudinal axis of elevator 600 along a direction extending between side walls 654, 656 of segment 602. Axle 670 may be received by an element of distal tip 20 of duodenoscope 10. For example, distal tip 20 may include a hole or recess that receives axle 670. Segment 602 may be rotatable about axle 670 relative to distal tip 20. Alternatively, the shaft 670 may be eliminated and the segments 602 may be fixed / non-rotatable relative to the distal tip 20 .

[0060] 7A , elevator 600 may be in a fully open configuration. A portion of guide surface 658 defined by base wall 652 may be generally planar / flat, including along the proximal and distal portions. In other words, segments 602, 604, 606, 608, 610 may be aligned to be substantially straight. An accessory tool inserted into the working channel of duodenoscope 10 may extend along guide surface 658 in a generally non-articulating configuration, with the accessory tool extending generally along the longitudinal axis of duodenoscope 10 / distal tip 20 and extending from distal tip 20.

[0061] In the configuration of FIG. 7B , distal segment 610 can be rotated / rocked relative to distal segment 608 by proximal movement of the control member. The control member can pull on segment 610, causing it to rock / rotate relative to segment 608 without moving segments 602, 604, 606, and 608. In the configuration of FIG. 7C , the control member can be moved further proximally compared to the configuration of FIG. 7B . The rotational / rocking relationship between segments 608 and 610 at hinge 628 can be maintained, and segment 608 can be rotated / rocked relative to segment 606 at hinge 626 without moving segments 602, 604, and 606. In the configuration of FIG. 7D , the control member can be moved further proximally compared to the configuration of FIG. 7C . The rotational / rocking relationships between segments 608 and 610 at hinge 628 and between segments 606 and 608 at hinge 626 may be maintained, and segment 606 may be rotated / rocked relative to segment 604 at hinge 624 without moving segments 602, 604. In the configuration of FIG. 7E , the control member may be moved further proximally compared to the configuration of FIG. 7D . The rotational / rocking relationships between segments 608 and 610 at hinge 628, between segments 606 and 608 at hinge 626, and between segments 604 and 606 at hinge 624 may be maintained, and segment 604 may be rotated / rocked relative to segment 602 at hinge 622 without moving segment 602. In a further configuration, not shown, the control member may be moved further proximally compared to the configuration of FIG. 7D to rotate segment 602 about axis 670. When the control wire is moved proximally, the elevator 600 may be lowered in the reverse order.

[0062] The handle 12 of the duodenoscope 10 may include features (e.g., markings or other visual or tactile feedback) for incrementally adjusting the elevator control lever 38 to enable articulation to predetermined configurations such as those shown in Figures 7A-7E. The handle 12 of the duodenoscope 10 may additionally or alternatively include a locking / retention mechanism for locking the elevator control lever 38 in a desired position, such as a position corresponding to one or more of the configurations of Figures 7A-7E.

[0063] 8A and 8B illustrate another exemplary elevator 700 that can be used with duodenoscope 10 and has any of the features of elevators 100, 200, 300, 400, 500, and 600 described above. FIG. 8A illustrates a perspective view of elevator 700, and FIG. 8B illustrates a view of the distal end of elevator 700 looking proximally. Reference numbers corresponding to elevators 500 and 600 (i.e., reference numbers having the same second and third digits) are used where possible. Elevator 700 can include multiple segments 702, 704, 706, 708, and 710 joined by hinges 722, 724, 726, and 728. As shown in FIG. 8A, segments 702, 704, 706, 708, and 710 can be formed from a single, integral piece of material with hinges 722, 724, 726, and 728, including living hinges. In the alternative, 702, 704, 706, 708, 710 may be formed from separate pieces joined together at hinges 722, 724, 726, 728. Any suitable type of hinge structure may be utilized for hinges 722, 724, 726, 728. As noted above, the number of segments / hinges illustrated is merely exemplary, and any suitable number of segments / hinges may be utilized.

[0064] Each of the segments 702, 704, 706, 708, 710 can have a base wall 752, a first side wall 754, and a second side wall 756 (labeled with respect to segment 710 in FIG. 7A and also present in segments 702, 704, 706, 708). The side walls 754 can each define a channel 760a (see FIG. 8B) that extends generally parallel to the longitudinal axis of the distal tip 20 of the elevator 700 / duodenoscope 10 (i.e., into / out of the page of FIG. 8B). The side walls 756 can each define a channel 760b (see FIG. 8B) that extends generally parallel to the longitudinal axis of the distal tip 20 of the elevator 700 / duodenoscope 10 (i.e., into / out of the page of FIG. 8B). The channels 760a, 760b may have any of the characteristics of the channels 660 of the elevator 600 described above.

[0065] A first control element 780a (having any of the control element characteristics described above) may extend through the channel 760a of each of the segments 702, 704, 706, 708, 710. A second control element 780b may extend through the channel 760b of each of the segments 702, 704, 706, 708, 710. A distal end 782a of the first control element 780a and a distal end 782b of the second control element 780b may each be coupled to a distal face (or other portion) of the segment 710 (i.e., the distal-most segment). For example, the distal ends 782a, 782b may extend transversely relative to more proximal portions of the first control element 780a and the second control element 780b, respectively (e.g., at an angle of about 90 degrees relative to the more proximal portions of the first control element 780a and the second control element 780b, respectively). Channels 760a, 760b may be located near the edges of side walls 754, 756, respectively, farthest from base wall 752. Distal ends 782a, 782b may extend toward base wall 752 and be secured to side walls 754, 756, respectively, of segment 710. For example, side walls 754, 756 may each include a protrusion 766 extending distally from a more proximal portion of side wall 754, 756, respectively. Distal ends 782a, 782b may be coupled to protrusion 766. Alternatively, control elements 780a, 780b may form a loop around or through segment 710 (i.e., may be a single continuous piece). For example, distal ends 782a, 782b may be coupled to each other and extend through side walls 754, 756 and base wall 752 of segment 710.

[0066] As shown in FIG. 8B , elevator 700 can be symmetrical about plane Z (i.e., the plane defined by the longitudinal axis of elevator 700 and an axis bisecting base wall 752 between side walls 754, 756). Control elements 780a, 780b can be coupled to the same elevator control lever 38. For example, the proximal ends of 780a, 780b can be coupled to elevator control lever 38 and / or to each other, or to a single control element (not shown) within shaft 18 or handle 12. Proximal or distal movement of control elements 780a, 780b can close or open elevator 700, respectively. The use of two control elements 780a, 780b can reduce the force required to be applied to elevator control lever 38 and generate a more uniform force on elevator 700. Alternatively, control elements 780a, 780b can be coupled to different actuators for independent articulation or to joystick-type actuators. In such a configuration, relative movement of one of the control elements 780a, 780b with respect to the other of the control elements 780a, 780b may enable bending of the elevator 700 in a direction transverse to the longitudinal axis of the elevator 700 (e.g., side-to-side articulation like the distal end of an articulatable shaft of a medical device such as a duodenoscope or other type of endoscope) or rotation of the elevator 700.

[0067] 9A-9C illustrate an alternative elevator 800, which may have any of the characteristics of elevators 100, 200, 300, 400, 500, 600, and 700, except as specified herein. FIG. 9A illustrates a perspective view of elevator 800, FIG. 9B illustrates a proximal-facing view of the distal end of elevator 800, and FIG. 9C illustrates a side view of elevator 800. Reference numbers corresponding to elevators 500, 600, and 700 (i.e., reference numbers having the same second and third digits) are used where possible. Elevator 800 may include multiple segments 802, 804, 806, 808, and 810 joined by hinges 822, 824, 826, and 828. 9A , segments 802, 804, 806, 808, 810 may be formed from a single, unitary piece of material with hinges 822, 824, 826, 828, including living hinges. Alternatively, segments 802, 804, 806, 808, 810 may be formed from separate pieces joined to one another at hinges 822, 824, 826, 828. Any suitable type of hinge structure may be utilized for hinges 822, 824, 826, 828. As noted above, the number of segments / hinges illustrated is merely exemplary, and any suitable number of segments / hinges may be utilized.

[0068] Each of segments 802, 804, 806, 808, 810 may have a base wall 852, a first side wall 854, and a second side wall 856 (labeled with respect to segment 810 in FIG. 7A and also present in segments 802, 804, 806, 808). Side walls 854 may each define a channel 860 (see FIG. 8B) that extends generally parallel to the longitudinal axis of the distal tip 80 of elevator 800 / duodenoscope 10 (i.e., into / out of the page in FIG. 9B). In contrast to elevator 700, side wall 856 may not define such a channel.

[0069] A control element 880 (having any of the control element features described above) may extend through the channel 860 of each of the segments 802, 804, 806, 808, 810. A distal end 882 of the control element 880 may be coupled to a distal face (or other portion) of the segment 810 (i.e., the distal-most segment). For example, the distal end 882 may extend transversely (e.g., at an approximately 90-degree angle relative to the control element 880) relative to a more proximal portion of the control element 880. The distal end 882 may extend toward the base wall 852 and be secured to the side wall 854 of the segment 810. For example, the side wall 854 may include a protrusion 866 extending distally from a more proximal portion of the side wall 854. The distal end 882 may be coupled to the protrusion 866.

[0070] Compared to sidewall 856, sidewall 854 may be wider in a direction B (see FIG. 9B ) extending between sidewalls 854 and 856, perpendicular to the longitudinal axis of elevator 800. The wider width of sidewall 854 compared to sidewall 856 may be due to the width of sidewall 854 required to define channel 860. It may be desirable for sidewall 856 to have a smaller wall width to conserve space within distal tip 20. It will be understood that the orientation of sidewalls 856, 854 is merely exemplary, and that sidewalls 856, 854 may be reversed relative to one another.

[0071] 10A-10C illustrate an alternative elevator 900, which may have any of the characteristics of elevators 100, 200, 300, 400, 500, 600, 700, and 800, except as specified herein. FIG. 10A illustrates a plan view of elevator 900, FIG. 10B illustrates a view of the distal end of elevator 900 looking proximally, and FIG. 10C illustrates a side view of elevator 900. Reference numbers corresponding to elevators 500, 600, 700, and 800 (i.e., reference numbers having the same second and third digits) are used where possible. Elevator 900 may include multiple segments 902, 904, 906, 908, and 910 joined by hinges 922, 924, 926, and 928. As noted above, the number of segments / hinges illustrated is merely exemplary, and any suitable number of segments / hinges may be utilized.

[0072] As shown in Figure 9A, segments 902, 904, 906, 908, 910 may be formed from separate pieces joined together by hinges 922, 924, 926, 928. Any suitable type of hinge structure may be utilized for hinges 922, 924, 926, 928. For example, as shown in Figure 9C, hinges 922, 924, 926, 928 may include pins 990 that may extend through all or part of the width (into / out of the page in Figure 9) of hinges 922, 924, 926, 928. For example, pins 990 may extend through openings in segments 902, 904, 906, 908, 910 to form segments 922, 924, 926, 928. Each of the segments 902, 904, 906, and 908 may include a protrusion 992 ( FIG. 10A ) that may extend from a distal side of the segment 902, 904, 906, and 908. The protrusion 992 may have, for example, a rectangular shape. Each of the segments 910, 908, 906, and 905 may include a corresponding notch 994 ( FIG. 10A ) formed on a proximal side of the segment 910, 908, 906, and 905. The notch 994 may have, for example, a rectangular shape. The notch 994 and the protrusion 992 may have complementary shapes such that the protrusion 992 may fit within the notch 994. The protrusion 992 may rotate relative to the notch 994 around the pin 990. For example, pin 990 may extend through an outer wall of a segment (e.g., segment 910), through an opening formed in a side wall of notch 994, through protrusion 992 of a proximally adjacent segment (e.g., segment 908), and through an opening formed in the other side wall of notch 994. Segments 910, 908 are referenced merely for illustrative purposes, and the same principles apply to the other segments. In an alternative example, a protrusion may extend proximally from a segment of elevator 900 (e.g., segment 910), and the proximally adjacent segment (e.g., segment 908) may include a corresponding notch for receiving the protrusion.

[0073] While the principles of the present disclosure are described herein with reference to illustrative examples of certain applications, it should be understood that the disclosure is not limited thereto. Those skilled in the art and with access to the teachings provided herein will recognize that additional modifications, adaptations, and equivalent substitutions all fall within the scope of the examples described herein. Moreover, various elements from each of the presented embodiments may be combined to achieve the same or similar results as one or more of the disclosed embodiments. Therefore, the present invention should not be deemed limited by the foregoing description.

Claims

1. 1. A medical equipment elevator, comprising: the elevator comprises a plurality of segments joined together by at least one hinge, a first segment of the plurality of segments being a separate structure; The elevator comprises a control element coupled to at least one of the plurality of segments, and proximal or distal movement of the control element is configured to move the at least one of the plurality of segments relative to another of the plurality of segments.

2. 10. The elevator of claim 1, wherein all of the plurality of segments are separate structures.

3. 2. The elevator of claim 1, wherein the plurality of segments comprises the first segment and a second segment.

4. 2. The elevator of claim 1, wherein in a first configuration, all of the plurality of segments lie along a substantially straight line.

5. The elevator of claim 4 , wherein the generally straight line is generally parallel to a longitudinal axis of the medical device.

6. 2. The elevator of claim 1, wherein the control element is a first control element, and the elevator further comprises a second control element coupled to at least one segment of the plurality of segments, and wherein proximal or distal movement of the second control element is configured to move the at least one segment of the plurality of segments relative to another segment of the plurality of segments.

7. 7. The elevator of claim 6, wherein each of the plurality of segments defines a first channel for receiving the first control element, and each of the plurality of segments defines a second channel for receiving the second control element.

8. 7. The elevator of claim 6, wherein the first control element is coupled to a first actuator of a handle of the medical device, and the second control element is coupled to a second actuator of the handle of the medical device, and the first actuator is operable separately from the second actuator.

9. The elevator of claim 1 , wherein a distal-most segment of the plurality of segments includes a socket on an outer surface of the distal-most segment, the socket configured to receive a distal end of the control element.

10. 2. The elevator of claim 1, wherein the first segment includes a first distal surface, a second segment of the plurality of segments includes a first proximal surface and a second distal surface, and a third segment of the plurality of segments includes a second proximal surface, the first distal surface of the first segment and the first proximal surface of the second segment being separated by a first angle, and the second distal surface of the second segment and the second proximal surface of the third segment being separated by a second angle, the second angle being different from the first angle.

11. 2. The elevator of claim 1, wherein each segment of the plurality of segments includes a base wall, a first side wall, and a second side wall, the first side wall of each segment defining a channel configured to receive the control element, and a width of the first side wall of each segment being greater than a width of the second side wall of each segment.

12. The elevator of claim 1 , wherein the at least one hinge comprises a pin or a rivet.

13. The elevator of claim 1 , wherein a distal-most segment of the plurality of segments includes a distally extending protrusion, the control element being secured to the protrusion.

14. The elevator of any one of claims 1 to 13, wherein the most proximal segment of the plurality of segments includes a shaft configured to be rotatably coupled to a distal tip of the medical device.

15. 15. The elevator of claim 14, wherein at least one of the plurality of segments is configured to rotate relative to the most proximal segment of the plurality of segments before the most proximal segment of the plurality of segments rotates relative to the distal tip of the medical device during distal movement of the control element.

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