Optically enhanced instrument with laser fluorescence capability

Abstract

To increase the volume for storing acquired sample tissue, thereby reducing or eliminating the need to remove an endoscope to empty a tissue retrieval device for another sample collection insertion iteration.SOLUTION: The surgical instrument includes an elongated body including a proximal end portion and a distal end portion, and a tissue separator coupled to the distal end portion and configured to engage a sample tissue for collection, wherein the tissue separator is at least partially made of a material that allows light to pass through the tissue separator. A method of collecting biological material using a tissue retrieval device includes inserting the tissue retrieval device into a patient's anatomy, guiding a tissue collector of the tissue retrieval device to a target tissue, viewing the target tissue through the tissue collector, and collecting biological material from the target tissue with the tissue retrieval device.SELECTED DRAWING: Figure 6B

Description

[Technical Field]

[0001] Priority claim This application claims the benefit of priority to U.S. Provisional Patent Application No. 63 / 092,664, filed October 16, 2020, U.S. Provisional Patent Application No. 63 / 127,483, filed December 18, 2020, and U.S. Provisional Patent Application No. 63 / 213,853, filed June 23, 2021, the contents of which are incorporated herein by reference in their entireties.

[0002] The present disclosure relates generally to medical devices that include an elongate body configured to be inserted into an incision or opening in a patient's anatomy to provide a diagnostic or therapeutic procedure.

[0003] More particularly, the present disclosure relates to medical devices that can be inserted into a patient's anatomy to perform a biological material removal process, such as by cutting sample tissue for analysis. [Background technology]

[0004] Endoscopes can be used for one or more of: 1) providing passage for other devices (e.g., therapeutic or tissue-collecting devices) to various anatomical portions, including the digestive tract (e.g., esophagus, stomach, duodenum, pancreatic bile duct, intestine, and colon), renal region (e.g., kidneys, ureters, bladder, urethra), and other internal organs (e.g., reproductive system, sinuses, submucosal areas, airways), etc.

[0005] Conventional endoscopes can be involved in a variety of clinical procedures, including, for example, illuminating, imaging, detecting, and diagnosing one or more disease states, providing fluid delivery (e.g., saline or other preparations via fluid channels) to an anatomical region, providing passage for one or more therapeutic devices (e.g., via a working channel) for sampling or treating an anatomical region, and providing an aspiration passage for collecting fluids (e.g., saline or other preparations).

[0006] In traditional endoscopy, the distal portion of the endoscope can be configured to support and orient a therapeutic device, such as by use of an elevator. In some systems, two endoscopes can be configured to work together, with the first endoscope guiding the second endoscope inserted therein with the aid of an elevator. Such systems can be useful in guiding an endoscope to anatomical locations in the body that are difficult to reach. For example, some anatomical locations can be accessed by an endoscope only after insertion through a circuitous path. [Prior art documents] [Patent documents]

[0007] [Patent Document 1] PCT Publication No. WO2011 / 140118A1 [Patent Document 2] U.S. Patent Application No. 17 / 100,025 Summary of the Invention [Problem to be solved by the invention]

[0008] The present disclosure recognizes that problems to be solved by conventional medical devices, and in particular endoscopes and duodenoscopes used to retrieve sample biological material, include, among other things, 1) the difficulty of navigating the endoscope (and instruments inserted therein) to locations in anatomical regions deep within the patient, 2) the disadvantage of only being able to obtain small tissue sample sizes, 3) the increased time and associated costs of having to repeatedly remove and reinsert the medical device to obtain a sufficient amount of sample material, and 4) the difficulty of incorporating features (e.g., maneuverability and tissue collection features) into small diameter devices without interfering with optical devices (e.g., imaging and illumination components) attached to the endoscope, among other things. Such problems may be particularly present in duodenoscope procedures (e.g., Endoscopic Retrograde Cholangio-Pancreatography, hereafter "ERCP" procedures), in which an auxiliary scope (also referred to as a daughter scope or cholangioscope) can be attached to and advanced through the working channel of a "main scope" (also referred to as a mother scope or duodenoscope). Additionally, tissue collection and retrieval devices used to remove sample material can be inserted through the auxiliary scope. As such, duodenoscopes, auxiliary scopes, and tissue retrieval devices are becoming increasingly smaller and more difficult to maneuver to perform interventions and treatments. [Means for solving the problem]

[0009] The present disclosure can help provide solutions to these and other problems by providing systems, devices, and methods related to inserting a tissue retrieval device (e.g., a biopsy forceps, etc.) through an auxiliary scope having a small diameter passageway. The tissue retrieval device can be tethered or otherwise attached to the distal end of the endoscope, allowing the tissue retrieval device to be sized beyond the constraints of the endoscope's lumen. The tissue retrieval device can thereby increase the capacity for storing retrieved sample tissue, thereby reducing or eliminating the need to remove the endoscope to empty the tissue retrieval device for another sample collection insertion iteration.

[0010] Moreover, to facilitate the navigation and tissue collection process of the endoscope with the tissue retrieval device positioned distally, the tissue retrieval device can be optically enhanced, such as by being made from a translucent or clear material to allow visibility of optical devices through and into the tissue retrieval device. Other optically enhanced materials can include reflective materials to allow interaction of light with the material to improve recognition by optical devices. Optically enhanced tissue retrieval devices can be configured to bend light waves, such as to provide optical magnification. Optically enhanced materials can enable viewing of 1) target tissue to be collected by the tissue retrieval device, 2) tissue inside the tissue retrieval device, 3) newly exposed tissue after some target tissue has been separated from the anatomical structure, and 4) components of the tissue retrieval device relative to the target tissue, as well as other benefits.

[0011] Additionally, due in part to being freed from the size constraints of an endoscope lumen, tissue collection devices can include features to facilitate obtaining multiple samples of tissue without previously collected samples being dislodged (e.g., dropped) from the tissue collection device and to increase the holding capacity of the tissue collection device. Thus, tissue collection devices can be configured to hold one or more pieces of sample material, thereby enabling the collection of multiple and larger samples in a single insertion pass.

[0012] As such, the present disclosure can help solve the above-referenced problems and other problems by 1) reducing the number of times a tissue retrieval device needs to be inserted and reinserted into an anatomical structure, and 2) increasing the volume of sample material collected with each insertion, among other things, such as by positioning the tissue retrieval device distal to the endoscope as described herein (the tissue retrieval device can be larger than the endoscope lumen to increase size and can be optically enhanced to reduce or eliminate interference with imaging capabilities).

[0013] The present disclosure also recognizes that problems to be solved in performing medical procedures include the ability to properly identify target tissue for removal. For example, ductal malignancies can include endometriosis and cancerous or pre-cancerous material (including carcinoma, sarcoma, myeloma, leukemia, lymphoma, and mixed-type cancers).

[0014] Treatment for these ductal malignancies can involve removing diseased tissue, either for its own sake or to perform a biopsy to determine the next course of action. As such, it is desirable to identify ductal malignancies so that other healthy tissue within the duct or abdomen is not unnecessarily removed and to prevent having to return to the patient in a follow-up procedure to remove additional tissue. For example, it is desirable to remove all of the endometrial tissue outside the uterus to treat the disease, and also to collect a sufficient volume of tissue to perform a biopsy.

[0015] The differentiation of endometrial and cancerous tissue can be facilitated by the use of dyes, whereby the patient ingests the dye, which can be metabolized into or otherwise absorbed by the endometrial and cancerous tissue. The dye can then be excited with light of a specific wavelength to illuminate the tissue containing the dye. However, the use of dyes requires that light be introduced into the surgical site, which typically requires the use of additional instruments. Moreover, it can be difficult to direct the excitation light onto the target tissue while operating the device to engage the tissue, for example, due to interference with the device itself or other instruments working with the device.

[0016] The present subject matter can provide solutions to this and other problems, such as by providing a system that incorporates a light emitter into a surgical instrument so that a surgical tool portion (e.g., a tissue collector or separator) of the surgical instrument can be directly illuminated via emitted light without the need for an additional or separate tool. Moreover, tissue collection devices can be made from transparent tissue separators and collectors (e.g., blades and jaws) to allow excitation light to pass through the tissue collector and excite the dye. Light can be provided at different wavelengths to provide different excitation for the tissue-illuminating dyes. Methods of performing surgical procedures with such systems are also described herein.

[0017] The terms "tissue retrieval device" and "biopsy instrument" are used throughout this disclosure, however, a tissue retrieval device or biopsy instrument can alternatively or additionally include a biological material collection device, a biological material retrieval device, a tissue collection device, and a tissue retrieval device.

[0018] In examples, the tissue separation device can include an elongate body including a proximal end portion and a distal end portion, and a tissue separator coupled to the distal end portion, the tissue separator configured to engage sample tissue for retrieval, the tissue separator being at least partially made from a material that allows light to pass through the tissue separator.

[0019] In another example, a method of collecting biological material using a tissue collection device can include inserting the tissue collection device into a patient's anatomical structure, guiding a tissue collector of the tissue collection device to a target tissue area, viewing the target tissue through the tissue collector, and collecting biological material from the target tissue with the tissue collection device.

[0020] In an additional example, the surgical instrument can include an endoscope and a tissue retrieval device. The endoscope can include an insertion shaft extending from a proximal end to a distal end, a working channel extending at least partially through the insertion shaft, and an imaging system coupled to the insertion shaft, the imaging system having a field of view that projects distally of the working channel. The tissue retrieval device can include an elongate shaft positionable within the working channel and a tissue collection device, the elongate shaft extending along an axis and configured for insertion into the anatomical structure, the tissue collection device coupled to the elongate shaft and configured to separate tissue from the anatomical structure, the tissue collection device being optically enhanced to interact with the field of view of the imaging system.

[0021] In an example, the biopsy instrument can include a tissue separator device and an elongated control element. The tissue separator device can include a base, a tissue separator mounted to the base, and an actuation mechanism coupled to the tissue separator. The elongated control element can be coupled to the actuation mechanism for manipulating the tissue separator. The tissue separator can be at least partially made from a material capable of transmitting light.

[0022] In another example, a method of collecting biological material using a biopsy device includes anchoring the biopsy device to a distal end portion of an endoscope, inserting the endoscope with the biopsy device into a patient's anatomy, guiding the biopsy device to a target tissue site, viewing the target tissue through the biopsy device, and collecting biological material from the target tissue site with the biopsy device.

[0023] In an example, the surgical instrument can include a scope and a tissue retrieval device. The scope can include an elongate body extending from a proximal end portion to a distal end portion; a working channel extending at least partially through the elongate body; an imaging component coupled to the elongate body, the imaging component having a field of view that projects distally of the working channel; and a first light emitter configured to project light from the elongate body at a first wavelength suitable for exciting the light-emitting material. The tissue retrieval device can include an elongate shaft positionable within the working channel to extend along an axis and configured for insertion into the anatomical structure; and a tissue collection device coupled to the elongate shaft and configured to separate tissue from the anatomical structure.

[0024] In another example, a method of collecting biological material using a tissue collection device can include inserting the tissue collection device into a patient's anatomical structure, guiding a tissue collector of the tissue collection device to a target tissue, illuminating the target tissue with excitation light, and collecting biological material from the target tissue with the tissue collector. [Brief explanation of the drawings]

[0025] [Figure 1] 1 is a schematic diagram of an endoscopy system including an imaging and control system and an endoscope (e.g., a duodenoscope) with which the biological material collection systems and devices of the present disclosure may be used. [Figure 2] 2 is a schematic diagram of the imaging and control system of FIG. 1 showing the imaging and control system connected to the endoscope. [Figure 3A]3 is a schematic top view of the distal portion of the endoscope of FIG. 2, including a camera module including the optical components and elevator mechanism of a side-viewing endoscope. [Figure 3B] 3B is an enlarged cross-sectional view taken along plane 3B-3B of FIG. 3A showing the optical component. [Figure 3C] FIG. 3C is an enlarged cross-sectional view taken along plane 3C-3C of FIG. 3A showing the elevator mechanism. [Figure 4] FIG. 1 is a schematic diagram of a distal portion of an endoscope being used to position an auxiliary scope adjacent to the duodenum, the auxiliary scope being configured to receive a tissue retrieval device (including a tethered biopsy instrument) of the present disclosure. [Figure 5A] 1 is a schematic diagram of a tissue retrieval device of the present disclosure including an elongated shaft and a translucent tissue collector. [Figure 5B] 5B is an enlarged view of the distal end of the tissue retrieval device of FIG. 5A showing a translucent tissue collector disposed within an auxiliary endoscope. [Figure 6A] FIG. 1 is a schematic diagram of a translucent tissue collector containing forceps in a closed position. [Figure 6B] FIG. 6B is a schematic diagram of the translucent tissue collector of FIG. 6A with the forceps open. [Figure 7A] FIG. 1 is a schematic diagram of a translucent tissue collector including a boring device extending from an endoscope having an imaging device. [Figure 7B] 7B is a schematic cross-sectional view of the translucent tissue collector of FIG. 7A with collected tissue inside the translucent tissue collector. FIG. [Figure 8A] FIG. 1 is a schematic diagram of an endoscopy system including an endoscope and an tethered biopsy instrument. [Figure 8B] FIG. 8B is a side view of a pair of forceps suitable for use as the biopsy instrument of FIG. 8A. [Figure 9] 1 is a schematic diagram of a biopsy instrument including forceps with a tissue retention system including a sponge and a needle. [Figure 10] 1 is a schematic diagram of a biopsy instrument including forceps with extendable jaws. [Figure 11] 1 is a schematic diagram of a biopsy instrument including forceps with flexible jaws. [Figure 12] FIG. 1 is a block diagram illustrating a method of collecting biological material from a patient using the tethered biopsy instrument of the present disclosure. [Figure 13] 1 is a schematic diagram of a tissue collection instrument including forceps having a light emitter configured to excite a light-emitting material. [Figure 14] FIG. 1 is a block diagram illustrating a method for illuminating tissue with a luminescent dye by a tissue collection device with built-in excitation capabilities and an optically enhanced tissue separator. [Figure 15] 1 is a block diagram illustrating a method of collecting biological material from a patient using the tissue collection device of the present disclosure. DETAILED DESCRIPTION OF THE INVENTION

[0026] FIG. 1 is a schematic diagram of an endoscopy system 10 including an imaging and control system 12 and an endoscope 14. The system of FIG. 1 is an illustrative example of an endoscopy system suitable for use with the systems, devices, and methods described herein (e.g., tethered and optically enhanced biological and tissue collection, retrieval, and storage devices and biopsy instruments that can be used to obtain samples of tissue or other biological material to be removed from a patient for analysis or treatment of the patient, etc.). According to some examples, the endoscope 14 may be insertable into an anatomical region for imaging and / or to provide passage or attachment thereto (e.g., via tethers) of one or more sampling devices for biopsies or one or more therapeutic devices for treatment of a disease state associated with the anatomical region. Advantageously, the endoscope 14 interfaces with and can be connected to the imaging and control system 12. In the illustrated example, the endoscope 14 includes a duodenoscope, although other types of endoscopes can be used with the features and teachings of the present disclosure.

[0027] The imaging and control system 12 may include a control unit 16 , an output unit 18 , an input unit 20 , a light source 22 , a fluid source 24 , and a suction pump 26 .

[0028] The imaging and control system 12 may include various ports for coupling with the endoscopy system 10. For example, the control unit 16 may include data input / output ports for receiving data from and communicating data to the endoscope 14. The light source 22 may include an output port for transmitting light to the endoscope 14, such as via a fiber optic link. The fluid source 24 may include a port for transmitting fluid to the endoscope 14. The fluid source 24 may include a fluid pump and tank or may be connected to an external tank, container, or storage unit. The suction pump 26 may include a port used to draw a vacuum from the endoscope 14 to generate suction, such as to draw fluid from the anatomical region into which the endoscope 14 is inserted. The output unit 18 and the input unit 20 may be used by an operator of the endoscopy system 10 to control functions of the endoscopy system 10 and to view the output of the endoscope 14. The control unit 16 may additionally be used to generate signals or other outputs for treating the anatomical region into which the endoscope 14 is inserted. In examples, the control unit 16 may generate electrical, acoustic, and fluid outputs, etc., to treat an anatomical region, for example, by cauterizing, cutting, freezing, etc.

[0029] The endoscope 14 may include an insertion section 28 , a function section 30 , and a handle section 32 , which may be coupled to a cable section 34 and a coupler section 36 .

[0030] The insertion section 28 can extend distally from the handle section 32, and the cable section 34 can extend proximally from the handle section 32. The insertion section 28 can be elongated and can include a bending section and a distal end, and the functional section 30 can be attached to the distal end. The bending section can be controllable (e.g., by a control knob 38 on the handle section 32) to navigate the distal end through tortuous anatomical passageways (e.g., the stomach, duodenum, kidney, ureter, etc.). The insertion section 28 can also be elongated and can include one or more working channels (e.g., internal lumens) that can support insertion of one or more therapeutic tools (e.g., the auxiliary scope 134 in FIG. 4 ) of the functional section 30. The working channels can extend between the handle section 32 and the functional section 30. Additional functionality (e.g., fluid passageways, guidewires, pullwires, etc.) can be provided by the insertion section 28 (e.g., via aspiration or irrigation passageways, etc.).

[0031] Handle section 32 can include a knob 38 and a port 40. Knob 38 can be coupled to a pull wire or other actuation mechanism that extends through insertion section 28. Port 40 can be configured to couple various electrical cables, guide wires, auxiliary scopes, tissue collection devices of the present disclosure, fluid tubing, etc. to handle section 32 for connection with insertion section 28.

[0032] By way of example, imaging and control system 12 may be provided on a mobile platform (e.g., cart 41) with shelves for housing light source 22, suction pump 26, image processing unit 42 (FIG. 2), etc. Alternatively, some components of imaging and control system 12 shown in FIGS. 1 and 2 may be provided directly on endoscope 14, making the endoscope "self-contained."

[0033] Functional section 30 may include components for treating and diagnosing a patient's anatomy. Functional section 30 may include imaging devices, illumination devices, and elevators (e.g., as further described with reference to elevator 54 in FIGS. 3A-3C ). Functional section 30 may further include optically enhanced biological material and tissue collection and retrieval devices as described herein. For example, functional section 30 may include one or more electrodes conductively connected to handle section 32 and operably connected to imaging and control system 12 for analyzing biological material in contact with the electrodes based on comparative biological data stored therein. In another example, functional section 30 may directly incorporate a tissue collector similar to the tissue retrieval device described with reference to FIGS. 5A-7B and the biopsy device described with reference to FIGS. 8A-11 .

[0034] FIG. 2 is a schematic diagram of the endoscopy system 10 of FIG. 1, including an imaging and control system 12 and an endoscope 14. FIG. 2 also schematically illustrates components of the imaging and control system 12 coupled to the endoscope 14, which in the illustrated example comprises a duodenoscope. The imaging and control system 12 may include a control unit 16, which may include or be coupled to an image processing unit 42, a therapy generator 44, and a drive unit 46, as well as a light source 22, an input unit 20, and an output unit 18. As discussed in more detail below with reference to FIGS. 4-5B, the control unit 16 may include or be in communication with an endoscope 100, a surgical instrument 200, and an endoscopy system 400, which may include devices configured to engage tissue to collect and store a portion of the tissue, and through which an imaging instrument (e.g., a camera) may view the target tissue via including optically enhanced materials and components. The control unit 16 can be configured to activate a camera, which can be fabricated from a translucent material, to view the target tissue distal to the surgical instrument 200 and the endoscopy system 400. Similarly, the control unit 16 can be configured to activate the light source 22 to illuminate the surgical instrument 200, which can include select components configured to reflect light in a particular manner (e.g., a tissue cutter enhanced with reflective particles, etc.).

[0035] The image processing unit 42 and the light source 22 may each interface with the endoscope 14 (e.g., at the functional unit 30) by a wired or wireless electrical connection. Thus, the imaging and control system 12 may illuminate an anatomical region, collect signals representative of the anatomical region, process the signals representative of the anatomical region, and display an image representative of the anatomical region on the display unit 18. The imaging and control system 12 may include a light source 22 for illuminating the anatomical region with a desired spectrum of light (e.g., broadband white light, narrowband imaging using a suitable electromagnetic wavelength, etc.). The imaging and control system 12 may be connected to the endoscope 14 (e.g., via an endoscope connector) for signal transmission (e.g., light output from the light source, video signals from the imaging system at the distal end, diagnostic and sensor signals from diagnostic devices, etc.).

[0036] Fluid source 24 (FIG. 1) may be in communication with control unit 16 and may include one or more sources of air, saline, or other fluids, as well as associated fluid paths (e.g., air channels, irrigation channels, aspiration channels) and connectors (such as barb fittings, fluid seals, and valves). Fluid source 24 may be utilized as activation energy for the biasing or pressure-applying devices of the present disclosure. Imaging and control system 12 may also include a drive unit 46, which may be an optional component. Drive unit 46 may include at least a motorized drive for advancing the distal section of endoscope 14, as described in PCT Publication No. WO 2011 / 140118 A1, entitled "Rotate-to-Advance Catheterization System," by Frassica et al., which is incorporated herein by reference in its entirety.

[0037] 3A-3C illustrate a first example of the functional section 30 of the endoscope 14 of FIG. 2. FIG. 3A illustrates a top view of the functional section 30. FIG. 3B illustrates a cross-sectional view of the functional section 30 taken along cross-sectional plane 3B-3B of FIG. 3A. FIG. 3C illustrates a cross-sectional view of the functional section 30 taken along cross-sectional plane 3C-3C of FIG. 3A. FIGS. 3A-3C illustrate a "side-viewing endoscope" (e.g., duodenoscope) camera module 50. In a side-viewing endoscope camera module 50, the illumination and imaging system are positioned so that the viewing angle of the imaging system corresponds to a target anatomical structure transverse to the central longitudinal axis A1 of the endoscope 14. However, the biological material retrieval device can be used with other types of endoscopes, such as "end-viewing endoscopes."

[0038] In the example of FIGS. 3A and 3B , the side-viewing endoscopic camera module 50 may include a housing 52, an elevator 54, a fluid outlet 56, an illumination lens 58, and an objective lens 60. The housing 52 may form a fluid-tight connection with the insertion section 28. The housing 52 may include an opening for the elevator 54. The elevator 54 may include a mechanism for moving a device (such as the auxiliary scope 134 of FIG. 4 ) inserted through the insertion section 28. Among other things, the elevator 54 may include a device capable of bending an elongated device extended through the insertion section 28 along the axis A1, as discussed in more detail with reference to FIG. 3C . The elevator 54 may be used to bend the elongated device at a predetermined angle relative to the axis A1, thereby treating or accessing an anatomical region adjacent to the side-viewing endoscopic camera module 50. The elevator 54 is positioned alongside (e.g., radially outward of) the axis A1, the illumination lens 58, and the objective lens 60.

[0039] As can be seen in FIG. 3B , the insertion section 28 can include a central lumen 62 through which various components (e.g., an auxiliary scope 134 ( FIG. 4 )) can extend to connect the function section 30 with the handle section 32 ( FIG. 2 ). For example, the illumination lens 58 can be connected to a light transmitter 64, which can include a fiber optic cable or cable bundle that extends to the light source 22 ( FIG. 1 ). Similarly, the objective lens 60 can be coupled to a prism 66 and an imaging unit 67, which can be coupled to wiring 68. Additionally, the fluid outlet 56 can be coupled to a fluid line 69, which can include a tube that extends to the fluid source 24 ( FIG. 1 ). Other elongated elements (e.g., tubes, wires, cables) may extend through lumen 62 to connect functional section 30 with components of endoscopy system 10, such as, for example, suction pump 26 (FIG. 1) and therapy generator 44 (FIG. 2).

[0040] FIG. 3C is a schematic cross-sectional view taken along cross-sectional plane 3C-3C of FIG. 3A showing elevator 54. Elevator 54 can include deflector 55, which can be disposed within space 53 of housing 52. Deflector 55 can be connected to wire 57, which can extend through tube 59 and connect to handle section 32. Wire 57 can be actuated, for example, by turning a knob, pulling a lever, or pressing a button on handle section 32. Movement of wire 57 can cause rotation (e.g., clockwise) of deflector 55 about pin 61 from a first position to a second position (indicated by 55′). Deflector 55 can be actuated by wire 57 to move a distal portion of instrument 63 extending through window 65 in housing 52.

[0041] The housing 52 may include a storage space 53 for storing the deflector 55. The instrument 63 may include a forceps, a guidewire, a catheter, or the like extending through the lumen 62. The instrument 63 may additionally include the auxiliary scope 134 of FIG. 4, a tissue collection device (e.g., the surgical instrument 200 and tissue retrieval device 300 (FIG. 7A) of FIGS. 5A-6B), and other instruments (e.g., the biopsy instrument 404 of FIG. 8A). The proximal end of the deflector 55 may be attached to the housing 62 by a pin 61 provided on the rigid tip 21. The distal end of the deflector 55 may be positioned below the window 65 within the housing 62 when the deflector 55 is in a lowered (or unactivated) state. The distal end of the deflector 55 may extend at least partially out of the window 65 when the deflector 55 is raised (or activated) by a wire 57. The instrument 63 can slide over the angled ramp surface 51 of the deflector 55, initially deflecting the distal end of the instrument 63 toward the window 65. The angled ramp surface 51 can facilitate extension of the distal portion of the instrument 63 from the window 65 at a first angle relative to the axis of the lumen 62. The angled ramp surface 51 can include a groove 69 (e.g., a V-notch) for receiving and guiding the instrument 63. The deflector 55 can be actuated to bend the instrument 63 at a second angle relative to the axis of the lumen 62, the second angle being closer to vertical than the first angle. When the wire 57 is released, the deflector 55 can be rotated (e.g., counterclockwise) and returned to the lowered position by either pushing or relaxing the wire 57. In an example, the instrument 63 can include a cholangioscope or an auxiliary scope 134 ( FIG. 4 ).

[0042] The side-viewing endoscopic camera module 50 of FIGS. 3A-3C may include optical components (e.g., objective lens 60, prism 66, imaging unit 67, wiring 68) for collecting image signals and illumination components (e.g., illumination lens 58, light transmitter 64) for transmitting or generating light. The endoscopic camera module 50 may also include photosensitive elements, such as a charge-coupled device ("CCD") sensor or a complementary metal-oxide semiconductor ("CMOS") sensor. In either example, the imaging unit 67 may be coupled (e.g., via a wired or wireless connection) to the image processing unit 42 (FIG. 2) to transmit signals from the photosensitive elements representing an image (e.g., a video signal) to the image processing unit 42 for display on a display (e.g., output unit 18). In various examples, the imaging and control system 12 and image processing unit 67 can be configured to provide output at a desired resolution appropriate for an endoscopy procedure (e.g., at least 480p, at least 720p, at least 1080p, at least 4K UHD, etc.).

[0043] Thus, as endoscope 100 is inserted further into the anatomy, complications arise as it must be maneuvered and twisted, as described with reference to FIG. 4. Moreover, to reach further into the anatomy, additional devices may be used (e.g., instrument 63 in the form of auxiliary scope 134). As such, the cross-sectional area (e.g., diameter) of subsequently nested devices becomes smaller, thereby requiring even smaller devices, which may be difficult to manufacture and manipulate, as described with reference to FIGS. 5A-7B, or may be difficult to produce satisfactory results without repeated intervention (e.g., patient interaction).

[0044] FIG. 4 is a schematic diagram of a distal portion of an endoscope 100 according to the present disclosure positioned in the duodenum D. The endoscope 100 may include a functional module 102, an insertion section module 104, and a control module 106. The control module 106 may include a controller 108. The control module 106 may include other components, such as those described with reference to the endoscopy system 10 ( FIG. 1 ) and the control unit 16 ( FIG. 2 ). Additionally, the control module 106 may include components for controlling a camera and a light source connected to the auxiliary scope 134 (e.g., an imaging unit 110, an illumination unit 112, and a power unit 114). The endoscope 100 may be configured similarly to the endoscope 14 of FIGS. 1 and 2.

[0045] The duodenum D can include a duct wall 120, a sphincter of Oddi 122, a common bile duct 124, and a main pancreatic duct 126. The duodenum D comprises the upper portion of the small intestine. The common bile duct 124 carries bile from the gallbladder and liver (not shown) and empties the bile through the sphincter of Oddi 122 into the duodenum D. The main pancreatic duct 126 carries pancreatic juice from the exocrine pancreas (not shown) to the common bile duct 124. At times, it may be desirable to remove biological material (e.g., tissue) from the bile duct 124 or pancreatic duct 126 and analyze the tissue to, for example, diagnose a disease or illness (e.g., cancer) in a patient.

[0046] Functional module 102 may include elevator portion 130. Endoscope 100 may further include lumen 132 and auxiliary scope 134. Auxiliary scope 134 may include lumen 136. Auxiliary scope 134 may itself include functional components (e.g., a camera lens 137 and an optical lens (not shown) coupled to control module 106) to facilitate navigation of auxiliary scope 134 from endoscope 100 through the anatomy and to facilitate viewing of components extending from lumen 132.

[0047] In a duodenoscopy procedure (e.g., an endoscopic retrograde cholangiopancreatography, hereafter "ERCP" procedure), an auxiliary scope (also referred to as a daughter scope or cholangioscope) (e.g., auxiliary scope 134) can be attached to and advanced through the lumen 132 (or the central lumen 62 of the insertion section 28 of endoscope 14 in FIG. 3B ) of a "main scope" (also referred to as a mother scope or duodenoscope) (e.g., endoscope 100). As discussed in more detail below, the auxiliary scope 134 can be guided into the sphincter of Oddi 122. From there, the surgeon operating the auxiliary scope 134 can navigate the auxiliary scope 134 through the lumen 132 toward the gallbladder, liver, or other locations in the digestive system to perform various procedures. The surgeon can navigate the auxiliary scope 134 beyond the entrance 128 of the main pancreatic duct 126 and into the passageway 129 of the common bile duct 124 or into the entrance 128. The auxiliary scope 134 can be used to guide additional devices to the anatomical structure to acquire biological material, such as by passing through or attaching to the lumen 136. The additional devices can have their own functional devices for the therapeutic procedure (e.g., light sources, cameras, tissue separators, accessories, biopsy channels, etc.). As described with reference to FIGS. 5A-7B, the additional devices can include various features (e.g., forceps or augers, etc.) for collecting biological material (e.g., tissue, etc.). As described with reference to FIGS. 8A-11, the additional devices can include a biopsy device tethered to the endoscope, which has tissue-collection-enhancing features. The biological material can then be removed from the patient, typically by removal of an additional device from the auxiliary device, so that the removed biological material can be analyzed to diagnose one or more conditions in the patient.According to some examples, the endoscope 100 may be suitable for removal of cancerous or precancerous material (e.g., carcinoma, sarcoma, myeloma, leukemia, and lymphoma), endometriosis evaluation, bile duct biopsy, and the like.

[0048] However, as mentioned above, the size of the additional devices is typically small due to the progressively smaller sizes of the endoscope 100, the auxiliary scope 134, and the additional devices. In an example, the lumen 132 of the endoscope 100 may typically be on the order of approximately 4.0 mm in diameter, while the lumen 136 of the auxiliary scope 134 may typically be on the order of approximately 1.2 mm. As such, with conventional devices, it may be difficult to obtain a sufficiently large tissue sample sized to ensure an accurate diagnosis without having to repeatedly remove and reinsert the additional device. Similarly, it may be difficult to view the desired substance (e.g., target tissue) due to several reasons, including the presence of the tissue collection device within the line of sight of the auxiliary scope camera, thereby making the collection of undesired (e.g., non-cancerous) material possible. However, with the systems and devices of the present disclosure, for example, when configured as a tissue collection device or biopsy instrument of the present disclosure, it is possible to obtain a sufficiently large tissue sample size with only a single insertion and removal of the additional device. For example, the tissue retrieval device can be fabricated partially or entirely from a translucent material, allowing the imaging device to have improved visibility of the tissue behind the tissue retrieval device. Additionally, the tissue retrieval device can be fabricated partially or entirely from a reflective material, allowing the imaging device to have improved visibility of certain components of the tissue retrieval device (e.g., functional components such as a tissue cutter, etc.). Moreover, the present disclosure includes tissue retrieval and biopsy devices that can be placed in front of an auxiliary scope and a lumen extending therethrough to increase the size and capacity of the tissue collection device.

[0049] FIG. 5A is a schematic diagram of a surgical instrument 200 including an elongated body 202, a tissue collection device 204, and a device controller 206. The surgical instrument 200 can include a device configured for the separation, collection, and recovery of biological material (e.g., tissue) from a patient. The tissue collection device 204 can include a separator 210, which, in the illustrated example, includes jaws 212 and hinges 214 and an activation mechanism 216. The controller 206 can include a handpiece or handle 218, which can include the activation mechanism 216 and a connector 220. The elongated body 202 can include a shaft 222 that can include a lumen 224. The controller 206 can be connected to the system control unit 16 ( FIGS. 1 and 2 ) via a cable 226 and through the use of the connector 220. The components illustrated in FIGS. 5A and 5B are not necessarily drawn to scale.

[0050] Tissue collection device 204 can be configured to separate and / or retrieve biological material from within a patient after being positioned within the patient by elongate body 202. Tissue collection device 204 can be configured to engage target tissue, separate the target tissue from the patient, and store the separated target tissue for removal from the patient (e.g., by removing elongate body 202 from the patient).

[0051] The handpiece 218 may include any suitable device for facilitating manipulation and operation of the surgical instrument 200. The handpiece 218 may be positioned at the proximal end of the shaft 222 or at another suitable location along the shaft 222. In examples, the handpiece 218 may include a pistol grip, a knob, and a handlebar grip. The actuation mechanism 216 may be attached to the handpiece 218 for operating the tissue collection device 204. The actuation mechanism 216 may include one or more of a button, a trigger, a lever, a knob, a dial, and the like. The actuation mechanism 216 may be coupled to the pressure application device 214 and may include any suitable device for enabling operation of the pressure application device 214 from the handpiece 218. As such, the actuation mechanism 216 may include a linkage positioned within the lumen 224 of the shaft 222 or alongside the shaft 222. In examples, the linkage can be a mechanical linkage, an electronic linkage, or an electrical linkage (e.g., a wire or cable, etc.), or an activation energy source (e.g., an electrical source, a fluid source, or a gas source (e.g., a tube or conduit, etc.)).

[0052] The shaft 222 can extend from the handpiece 218 and can include an elongated member configured to allow the tissue collection device 204 to be inserted into a patient. In an example, the shaft 222 can be sized to fit within an auxiliary scope (such as, for example, the scope 134 of FIG. 4 ). As such, the shaft 222 can be inserted into an incision in the patient's epidermis, through a body cavity, or into an organ. Therefore, to facilitate minimally invasive surgical procedures, it is desirable for the diameter or cross-sectional shape of the shaft 222 (and components attached thereto) to be as small as possible. Thus, the tissue collection device 204 can be incorporated into the shaft 222 to minimize its size impact on the surgical instrument 200 and without interfering with linkages. The shaft 222 is axially rigid but resiliently bendable and can be formed from a metal or plastic material.

[0053] The tissue collection device 204 can be positioned at the distal end of the shaft 222 or at another suitable location along the shaft 222. The tissue collection device 204 can be sized, for example, to fit within the lumen 136 (FIG. 4). The tissue collection device 204 can include a component or device for interacting with the patient (e.g., configured to cut, slice, pull, saw, punch, twist, auger, or the like). Specifically, the separator 210 can include any device suitable for removing tissue from the patient (e.g., a blade, punch, scraping device, auger, or the like). In an additional example, the separator 212 can include a device configured to scrape or scrape tissue from the patient (e.g., a brush or grater device, or the like). In another example, the separator 212 can include a roughened surface (e.g., a surface coated with hard particles (e.g., diamond particles or sand particles, or the like)). The separator 210 can be configured to physically separate a portion of a patient's tissue from other, larger portions of tissue within the patient. In an additional example, the separator 210 can be configured to simply collect biological material from the patient that does not require physical separation (e.g., mucus or fluid, etc.). In an example, the separator 212 can be configured to physically separate a portion of a patient's tissue for collection by a tissue collection device or another device. In the illustrated example, the separator 210 can include forceps having jaws 212 pivotally connected at a hinge 214. However, the separator 210 can be configured as a variety of devices (e.g., punches, augers, blades, saws, etc.) capable of collecting biological material. Similarly, the separator 210 can incorporate features (e.g., containers or storage spaces, etc.) for storing collected material.In an example, a storage space can be provided between the jaws, as discussed with reference to FIGURE 6A. Separator 210 can include forceps, as described with reference to FIGURES 6A and 6B, or an auger, as described with reference to FIGURES 7A and 7B. In any configuration, a portion of separator 210 can be configured to allow light to pass therethrough or to reflect light incident thereon, selectively enhancing images of separator 210 and the anatomical structure acquired by the imaging unit.

[0054] The jaws 212 can be configured as a container or walled element for holding and retaining biological material collected by the tissue collection device 204. In an example, the jaws 212 can include a flexible basket that can be deformed to allow a portion of the jaws 212 to be brought into intimate contact with the target tissue. For example, the jaws 212 can be fabricated from a woven material (e.g., strands of Kevlar, PVC, polyethylene, polycarbonate, PEEK, and the like). The jaws 212 can be coupled to a structural component (e.g., a frame) to facilitate coupling to the shaft 222, facilitate attaching a cutting element (e.g., a tooth or blade, etc.) to the jaws 212, and provide stability to the separator 210. In an additional example, the jaws 212 can include a structural element, such as a box fabricated from a rigid and non-flexible material.

[0055] The handpiece 218 can be operated by a user to operate the tissue collection device 204. The handpiece 218 can be used to manipulate the shaft 222 and press the separator 210 against the target tissue. For example, the shaft 222 can be rotated, oscillated, reciprocated, etc., to move the separator 210 along the target tissue and cause the separator 210 to separate the sample tissue from the target tissue attached to the patient. The activation mechanism 216 can be coupled to the handpiece 218 and configured to operate the separator 210. The activation mechanism 216 can include any type of device suitable for activating the different types of separator devices described herein. In examples, the activation mechanism 216 can include one or more of a lever, a trigger, a joystick, a button, a wheel, etc., as well as combinations thereof. In an example, the activation mechanism 216 can include a wheel that can be rotated in one direction to open the jaws 212 and can be rotated in the opposite direction to close the jaws 212. For example, the wheel can be rotated to push and / or pull a wire to open and close the jaws 212.

[0056] 5B is an enlarged view of the distal end of the tissue collection device 204 of FIG. 5A, showing the translucent tissue separator 210 extending from the auxiliary endoscope 230. The endoscope 230 may include an example of the auxiliary scope 134. The endoscope 230 may include a shaft 232, a working channel 234, a passageway 236, and a lens 238. A field of view 240 may be projected from the lens 238. The endoscope 230 may additionally include a lens 239 for projecting light into the field of view 240.

[0057] Tissue collection device 204 can be configured as a low-profile device, allowing it to be inserted through a small diameter lumen (such as lumen 136 of auxiliary scope 134 in FIG. 4 ). Additionally, tissue collection device 204 can be configured as a high-volume tissue collector, which can hold a large volume of collected sample tissue, thereby reducing or eliminating the need to repeatedly remove surgical instrument 200 from the auxiliary scope. Moreover, tissue collection device 204 can be optically enhanced to facilitate user movement of tissue collection device 204 to interact with target tissue. For example, jaws 212A and 212B can be made from a translucent material, allowing lens 238 to view through jaws 212A and 212B, and teeth 213 can be made from a reflective material, reflecting light from lens 239 back to lens 238, allowing the user to more clearly visualize where tissue collection device 204 will interact with the patient's target tissue. Jaws 212A and 212B can be further configured to provide magnification of the target tissue when viewed through one or both of jaws 212A and 212B. In an example, one or both of jaws 212A and 212B can include one or more convex surfaces of a transparent material to provide optical magnification.

[0058] Tissue collection device 204 can be fully retracted into working channel 234, which can include lumen 136 of FIG. 4. As such, lens 238 can be freely moved by manipulation of shaft 232 to position target tissue within field of view 240. However, when it is desired to extend tissue collection device 204 from working channel 234, tissue collection device 204 can become positioned within field of view 240, thereby blocking or preventing lens 238 from capturing an image of the target tissue. As discussed with reference to FIGS. 6A-7B , tissue collection device 204 can be configured to allow light 1) to pass through a component, portion, or all of collector 210 and / or 2) to be reflected by a component, portion, or all of collector 210 to enhance the image obtained through lens 238.

[0059] Figure 6A is a schematic illustration of surgical instrument 200 in which separator device 210 includes forceps 250 in a closed position and extended from endoscope 230 adjacent target tissue 254. Figure 6B is a schematic illustration of surgical instrument 200 in which separator device 210 is in a deployed position and forceps 250 are in an open position to engage target tissue 254. Figures 6A and 6B are discussed simultaneously, and the components therein are not necessarily drawn to scale.

[0060] 6A, the tissue collection device 204 can be positioned in an anatomical conduit 255 in which a target tissue 254 is located. The shaft 222 can be used to guide the separator 210 through the anatomical conduit to the target tissue 254. The target tissue 254 may include a protrusion (e.g., a growth of cancerous or pre-cancerous material).

[0061] Endoscope 230 can be positioned so that lens 238 faces target tissue 254. As such, target tissue 254 can be within a field of view 240 of lens 238. Field of view 240 is illustrated as having a particular viewing angle. However, lens 238 can be configured to have a field of view 240 having a different angle up to and including 108 degrees. As can be seen in FIG. 6A , tissue collection device 204 is extended from shaft 232, exposing jaws 212A and 212B, but not yet engaging target tissue 254. As such, jaws 212A and 212B can therefore be positioned so as not to completely block field of view 240 from target tissue 254. However, field of view 240 can become obstructed the further tissue collection device 204 is extended from working channel 234. For example, the portion of the conduit 255 from which the target tissue 254 extends may become obstructed from view by the lens 238 .

[0062] 6B is a side view of tissue collection device 204 with jaws 212 shown in cross section to show storage space 256 with sample tissue 258. Jaws 212 can be elongated in a radial direction (e.g., up or down relative to the orientation of FIG. 6B) to form a container for storage of collected material.

[0063] With the jaws 212 rotated away from each other at the hinge 214, the tissue collection device 204 can be moved axially toward the sample tissue 258. The jaws 212 can be rotated toward each other to engage the target tissue 254. The tissue collection device 204 can be reciprocated back and forth along the axis of the shaft 222 to collect the sample tissue 258. The teeth 213 can be used to cut, saw, tear, or peel a portion of the target tissue 254 away from the patient's anatomy. In an example, only one of the jaws 212A and 212B can be configured to rotate.

[0064] Teeth 213 can be fabricated from the edges of jaws 212A and 212B. In an example, teeth 213 can include extensions of the material of jaws 212A and 212B. In such an example, teeth 213 and both jaws 212A and 212B can be fabricated from a rigid material such as plastic or metal. In an example, jaws 212A and 212B can be fabricated from Gorilla Glass®, available from Corning, or other chemically strengthened glass (e.g., alkali aluminosilicate sheet glass, etc.). In an example, jaws 212A and 212B can be fabricated from molded polycarbonate.

[0065] In a further example, the teeth 213 and jaws 212A and 212B can be attached to a frame extending from the hinge 214. For example, the jaw 212A can include a U-shaped rigid frame having end portions extending from the hinge 214 to form a bounded space. The jaw 212A can include a bag or bellows of flexible material attached to the U-shaped rigid frame to partially enclose the bounded space. The teeth 213 can extend from the U-shaped rigid frame to separate from the partially enclosed space. The jaw 212B can be similarly configured with teeth 213 configured to mesh with the teeth 213 of the jaw 212A. Thus, the flexible material of the jaws 212A and 212B can form a complete enclosure when the jaws 212A and 212B are rotated into engagement, yet can flex so as not to interfere with the teeth 213 engaging the target tissue 254.

[0066] The teeth 213 can be configured to have one or more orientations. For example, the teeth 213 can be angled distally toward the target tissue 254 or angled proximally toward the shaft 222. In an example, some of the teeth 213 can be angled proximally and some of the teeth 213 can be angled distally. In an example, the teeth 212 can be oriented in different directions.

[0067] As discussed above, components or portions of tissue collection device 204 can be made from optically enhanced materials. In an example, jaws 212A and 212B can be made from a translucent or transparent material, which can allow light waves to travel therethrough, thereby allowing lens 238 to “see through” jaws 212A and 212B. A transparent material can allow lens 238 to see the natural coloration of target tissue 254. A translucent material can be configured to allow lens 238 to view target tissue 254 in a filtered manner. As such, jaws 212A and 212B can be translucently colored with different colors to enhance the visibility of certain tissue types or diminish the visibility of other tissue types.

[0068] However, to maintain control of the tissue collection device 204 (e.g., to maintain accurate use of the teeth 213), portions of the tissue collection device 204 can be opaque, reflective, or translucent. In particular, the teeth 213 can be made from an opaque, reflective, or translucent material or can have a coating applied to it. In an example, the teeth 213 can be opaque so that they can be easily viewed by the lens 238. In an additional example, the teeth 213 can be configured to optically interact with light from the lens 239. For example, the teeth 213 can have a reflective coating applied to them (e.g., a coating of reflective particles or titanium oxide granules, etc.). Thus, light from the lens 239 can bounce back to the lens 238. In an additional example, the teeth 213 can be fluorescent so that they brighten when engaged by a particular type of light. Thus, light from the lens 239 can cause the lens 238 to view the teeth 213 at a particular wavelength that is more distinguishable from the conduit 255. In an example, only some of the teeth 213 may be reflective or fluorescent.

[0069] In view of the foregoing, the use of an optically enhanced tissue collection device can facilitate viewing of target tissue 254 through jaws 212A and 212B, viewing of sample tissue 258 within jaws 212A and 212B, and viewing of laceration 260 where sample tissue 258 has been removed from target tissue 254. As such, endoscope 230 can be used to view the internal tissue layers within laceration 260 and potentially diagnose conditions of that tissue.

[0070] Figure 7A is a schematic illustration of tissue retrieval device 300 including boring device 302, which can be inserted into endoscope 304. Figure 7B is a side view of tissue retrieval device 300 of Figure 7A with boring device 302 shown in cross section to show storage space 306 with sample tissue 308. Figures 7A and 7B are discussed simultaneously, and components therein are not necessarily drawn to scale.

[0071] The tissue retrieval device 300 may further include a shaft 310. The boring device 302 may include a container 312, a boring land 314, a blade 316, and a bore 318. The endoscope 304 may be configured similarly to the endoscope 230 of FIGS. 6A and 6B and may include another example of the auxiliary scope 134. The endoscope 304 may include a shaft 320, a working channel 322, a passageway 324, and a lens 326. A field of view 328 may be projected from the lens 326. The endoscope 304 may further include an optical lens 329 for projecting light of one or more wavelengths onto the target tissue 330.

[0072] The tissue retrieval device 300 can be configured to engage target tissue 330 in the axial direction of arrow B. For example, the tissue retrieval device 300 can be positioned in front of a tissue mound or protrusion or adjacent to a tissue wall. The shaft 306 can be advanced by a user in the direction of arrow B to engage the target tissue 330. The boring device 302 can be configured as a punch. The container 312 can have a conical shape and can include a distal bore 318 that can be configured to push through tissue. Thus, the tissue retrieval device can be configured to penetrate tissue and obtain a tissue sample, such as in tree core sampling. The distal or leading edge of the bore 318 can be sharpened. In such a configuration, the land 314 and blade 316 can be omitted from the container 312.

[0073] In the example, the boring device 302 can be configured as an auger. As such, the container 312 can have a conical shape, with lands 314 wrapped around the container 312 in a spiral fashion. The lands 314 can be configured to engage tissue and allow the container 312 to penetrate the tissue in the direction of arrow B. In some situations, for example, due to slippery or wet conditions, the boring device 302 can slip over the target tissue. Thus, it can be difficult or impossible to sufficiently engage the tissue to collect the desired volume of sample tissue. The lands 314 can be configured to facilitate engagement with the tissue. The shaft 306 can be rotated by the operator, rotating the container 312 and the lands 314. As the lands 314 are rotated, they can grip the tissue and cause further axial penetration of the boring device 302 into the tissue. As such, the distal tip of container 312 can maintain engagement with the tissue as boring device 302 is advanced forward. As container 312 enters the tissue, blade 316 can be configured to slice or scrape the tissue away from the patient. Blade 316 can include a sharpened edge of the opening in container 312 and can be configured similar to a potato peeler. In examples, only one of blade 316 and bore 318 can be used; however, as shown, both can be included.

[0074] Additionally, in various examples, the container 312 can be configured with an interior space for capturing and retaining sample tissue collected by the bore 318 and / or blade 316 .

[0075] As discussed herein, features of boring device 302 can be optically enhanced to interact with the light emitted at the point of view of lens 326 and optical lens 329. For example, container 312 can be fabricated from a transparent or translucent material. As such, a line of sight 340 can extend from lens 326, through container 312, to laceration 342 where sample tissue 308 was removed from target tissue 330. Additionally, a line of sight 344 can extend from lens 326, through container 312, to sample tissue 308 within container 312.

[0076] Other features of boring device 302 can be configured to interact with light from lens 329. For example, boring land 314, blade 316, and bore 318 can be made from or coated with a material to reflect light or be luminescent.

[0077] Thus, as discussed herein, boring device 302 can be optically enhanced to hide or obscure portions of the device by being transparent or translucent, and to visually brighten or highlight other portions of the device by being reflective or luminescent. Thus, portions of boring device 302 (e.g., those not functionally important to identifying and removing target tissue) can be optically minimized to reduce noise in the imaging signal for the operator, and portions of boring device 302 (e.g., those functionally important to identifying and removing target tissue) can be optically maximized to increase visibility in the imaging signal for the operator.

[0078] 8A is a schematic diagram of an endoscopy system 400 including an endoscope 402 and a biopsy instrument 404. The biopsy instrument 404 can be tethered to a distal end portion of the endoscope 402 for insertion into a patient's anatomy, thereby facilitating the collection of large volumes of sample tissue without the need to repeatedly reinsert the endoscope 402 into the patient.

[0079] The biopsy instrument 404 may include a device configured for separating, collecting, and / or retrieving biological material (e.g., tissue, etc.) from a patient. In an example, the biopsy instrument 404 may be configured as a forceps, as shown in FIG. 8B . The biopsy instrument 404 may include a separator 406, which in the illustrated example may include jaws 408A and 408B, a hinge 410, a base 412, control cables 414A and 414B, and couplers 416A and 416B. The biopsy instrument 404 may additionally include a handpiece 418 and couplers 420A and 420B. The handpiece 418 may be operably coupled to the control unit 16 ( FIGS. 1 and 2 ) via a connector 421 and a cable 419.

[0080] The endoscope 402 may include a shaft 422, a lumen 424, a handpiece 426, controls 428, a connector 430, and a cable 432. The handpiece 426 may include a controller for operating the functions of the endoscope 402. For example, the controls 428 may include a knob for activating a pull wire in the shaft 422. The handpiece 426 may be connected to the system control unit 16 (FIGS. 1 and 2) via the cable 432 and through the use of the connector 430. The components illustrated in FIG. 8A are not necessarily drawn to scale.

[0081] The endoscope 402 can include components and features as described with reference to the endoscope 230 and the endoscope 304 of Figures 5B-7B. The endoscope 402 can include steering capabilities (e.g., pull wires), illumination capabilities (e.g., light emitters), guidance capabilities (e.g., cameras or imaging systems), and fluid capabilities (e.g., irrigation and aspiration capabilities). Among other things, the endoscope 402 can be configured to operate with a working tool using a lumen 424. The lumen 424 provides a connection between the distal-most end 434 of the shaft 422 and a handpiece 426 such that an instrument can be inserted into the lumen 424 and function within the anatomy through the distal end of the shaft 422 and controlled at the proximal end 436 of the endoscope 402 via the handpiece 426.

[0082] The biopsy instrument 404 can include a working tool configured to retrieve, remove, and collect biological material from within a patient. In the illustrated example, the biopsy instrument 404 includes forceps. However, other biopsy instruments or working tools can also be used, such as the boring device 302 of FIGS. 7A and 7B, as well as other devices described herein.

[0083] Base 412 can include components for mounting separator 406 thereon, which can engage shaft 422. In an example, base 412 can be configured to abut distal-most end 434 to be held in place by control cables 414A and 414B. In other examples, base 412 can be configured to couple to distal-most end 434, such as via a threaded coupling, a protrusion that can provide an interference fit with lumen 424, a quick-connect coupling, or a magnetic coupling. Hinge 410 can include an axis or pivot point attached to base 412, upon which one or both of jaws 408A and 408B can pivot. Thus, jaws 408A and 408B can be attached to hinge 410.

[0084] Control cables 414A and 414B can extend from jaws 408 and 408B through, alongside, or around base 412 for extension into lumen 424. Control cables 414A and 414B can include various devices or components that enable remote (e.g., proximal) control of biopsy instrument 404. In an example, control cables 414A and 414B can include wires or cables configured to pull components of biopsy instrument 404. In the illustrated example, two control cables are shown for operation of jaws 408A and 408B. However, only one control cable can be used, or three or more control cables can be used.

[0085] The proximal ends of the control cables 414A and 414B may be provided with couplers 416A and 416B, respectively. The couplers 416A and 416B may be connected to couplers 420A and 420B of the handpiece 426. The coupling of the couplers 416A and 416B with the couplers 420A and 420B, respectively, may enable the transmission of actuation forces through the control cables 414A and 414B from the handpiece 426 to the biopsy instrument 404. Thus, the handpiece 426 may be operated to pull and push the control cables 414A and 414B or may include buttons, knobs, levers, etc. for pulling and pushing the control cables 414A and 414B. In an example, the couplers 416A and 416B may include plugs, and the couplers 420A and 420B may include sockets. In examples, couplers 416A and 416B may include loops or eyelets, and couplers 420A and 420B may include latches, clips, hooks, etc., or vice versa.

[0086] Biopsy instrument 404 is shown in FIG. 8A as a mechanically actuated biopsy instrument. However, in examples, an electrically actuated biopsy instrument can be provided, where one or more control cables are configured to deliver at least one of power and control signals to the biopsy instrument. As such, the biopsy instrument can include an electrically activated device, for example, via an electric motor or actuator. Correspondingly, handpiece 426 can include appropriate actuators (e.g., buttons, switches, etc.) for operating the electrical components of such a biopsy device.

[0087] Typically, an endoscope is inserted into a patient's anatomy, and then a working tool is inserted through the endoscope. As such, as discussed above, the working tool (especially the distal functional end of the working tool) must be sized to fit within the lumen of the endoscope, which limits the size of the functional end and the working tool disposed therein, since the working lumen is necessarily smaller than the cross-section of the endoscope. As noted above, a typical working tool lumen (such as lumen 424) can be configured to have a diameter of approximately 1.2 mm.

[0088] The devices and systems of the present disclosure allow working tools to include functional elements larger than the typical working tool lumen of an endoscope by providing a working tool that can be attached to the distal end of the endoscope prior to insertion. The working tool lumen can be used for the passage of control elements from the working tool, which can be proximally coupled to a controller or handpiece for the working tool. The working tool can be sized larger than the working tool lumen and can extend radially beyond the working tool lumen relative to the longitudinal axis of the endoscope. To facilitate such capabilities, the working tool can include components fabricated from materials that allow the passage of light (e.g., transparent or translucent materials) to minimize interference with the imaging and illumination capabilities of the endoscope.

[0089] Biopsy instrument 404 can be coupled to endoscope 402 via insertion of couplers 416A and 416B into lumen 424 at distal-most end 434. Couplers 416A and 416B can extend through shaft 422 and handpiece 426 and extend from proximal end 436. Base 412 can abut, and in some instances, be attached to, shaft 422. Couplers 416A and 416B can link with couplers 420A and 420B of handpiece 418. Handpiece 418 can be attached to handpiece 426 via any suitable coupling (e.g., threaded fasteners, snap-fit ​​couplers, hook-and-loop fasteners, etc.). In examples, the tension applied to control cables 414A and 414B between base 412 and hand piece 418 by joining couplers 416A and 416B and couplers 420A and 420B may be sufficient to join biopsy instrument 404 and hand piece 418 to endoscope 402. So configured, separator 406 can be tethered to shaft 422. However, separator 406 can be attached by other tethering arrangements (e.g., such as those discussed herein with reference to base 412).

[0090] When assembled, biopsy device 404 can be positioned at distal-most end 434 to be manipulated at the proximal end by a user. Jaws 408A and 408B can be sized larger than lumen 424, thereby having a larger internal volume, which allows a larger volume of tissue sample to be obtained. To facilitate movement of biopsy device 406 larger than lumen 424 (which would potentially obstruct lenses 238 and 239 ( FIG. 6A )), jaws 408A and 408B can be made from an optically transparent material, as described throughout this application. Furthermore, to facilitate collection of a large volume of sample biological material, for example, via performing multiple collection actions (e.g., “bites”) with forceps including biopsy instrument 404.

[0091] FIG. 8B is a side view of a forceps 438 suitable for use as a biopsy device of the present disclosure. The forceps 438 can include a base 440, jaws 442A and 442B, a hinge 444, actuators 446A and 446B, and control wires 448A and 448B. The forceps 438 is described with reference to engagement with the endoscope 230 in FIG. 5B for illustration of the imaging lens 238 and the illumination lens 239. The base 440 can be configured to engage the shaft 232. The base 440 can abut the distal-most surface of the shaft 232 and can be configured to be taller than the height H1 of the working channel 234, thereby preventing the base 440 from entering the working channel 234. In examples, base 440 can fit flush with shaft 232 and provide a stable connection to shaft 232, thereby preventing rocking or vibration and allowing jaws 442A and 442B to firmly engage target tissue. As mentioned, base 440 can additionally be configured to be securely held in place relative to shaft 232, such as via a mechanical coupling.

[0092] Hinge 444 can include a connection point for jaws 442A and 442B to couple to base 440. Hinge 444 can include a rounded pin or shaft onto which corresponding bores in jaws 442A and 442B can fit. Thus, jaws 442A and 442B can be configured to rotate freely on hinge 444. However, rotation of jaws 442A and 442B on hinge 444 can be controlled by control wires 448A and 448B. Control wires 448A and 448B can be coupled to actuators 446A and 446B of jaws 442A and 442B, respectively. Actuators 446A and 446B can include levers extending at an angle from jaws 442A and 442B relative to the centerline of working channel 234. Thus, control wires 448A and 448B can be operated by handpiece 418 to pull actuators 446A and 446B, rotating jaws 442A and 442B about hinge 444 to facilitate collection of a tissue sample. In examples, control wires 448A and 448B can be pre-bent to apply a rotational biasing force to actuators 446A and 446B toward an open or closed position. However, in examples, actuators 446A and 446B can be provided with other biasing elements (e.g., springs, etc.). As such, pulling control wires 448A and 448B can cause jaws 442A and 442B to open or close as desired. As shown, jaws 442A and 442B can include teeth to facilitate cutting and tearing tissue away from anatomical structures. Although the illustrated example is shown with reference to an actuator including a lever, other actuators (eg, pull rods or screw mechanisms) can also be used.

[0093] As shown, jaws 442A and 442B can extend radially beyond height H1 of working channel 234 so as to interfere with lenses 238 and 239. In an example, working channel 234 can have a height H1 of 1.2 mm. Notably, jaw 442A can extend radially above working channel 234 so as to be positioned between lenses 238 and 239 and target tissue distal to endoscope 230. As such, jaws 442A and 442B can be made from a material that allows light to pass therethrough (e.g., a transparent material, a translucent material, a partially opaque material, etc.), as described herein, so that jaws 442A and 442B prevent lenses 238 and 239 from interfering with providing guidance and target tissue acquisition to endoscope 230, such as by providing tissue imaging. As such, jaws 442A and 442B can be larger than working channel 234 without interfering with the operation of endoscope 230.

[0094] Figures 9-11 illustrate examples of biopsy instruments suitable for use with the present disclosure. Figures 9-11 illustrate simplified diagrams of forceps 438 of Figure 8B. However, other tissue collection or retrieval devices and other forceps configurations can also be used.

[0095] 9 is a schematic diagram of a biopsy instrument 450 including a forceps 452 with a tissue retention system including a sponge 454 and a needle array 456. The forceps 452 can include jaws 458A and 458B, a hinge 460, and a base 462. The jaws 458A and 458B can include teeth 464. The needle array 456 can include a base 464 and needles 466. A tissue sample 468 can be positioned between the jaws 458A and 458B. The sponge 454 can include an elastically deformable body portion that can be deformed by the presence of sample tissue in the jaws 458A and 458B but tends to maintain its shape to apply a retaining force to the sample tissue. The needles 466 can include tines or pins configured to pierce the sample tissue and the sponge 454.

[0096] Sponge 454 and needle array 456 can include volume-enhancing features that allow jaws 458A and 458B to hold a larger volume of sample tissue than without sponge 454 and needle array 456. Sponge 454 can be attached to the internal cavity of jaw 458A, such as via an adhesive or any suitable manner, and can be used to bias tissue sample 468 toward 458B. Base 464 can be attached to the internal cavity of jaw 458B, such as via an adhesive or any suitable manner. As such, jaws 458A and 458B can be used to acquire tissue sample 468 and position tissue sample 468 between jaws 458A and 458B, such as by using control wires 448A and 448B. Jaws 458A and 458B can then be reopened to obtain an additional tissue sample, and sponge 454 can push tissue sample 468 into needles 466 and prevent tissue sample 468 from falling out of forceps 452. In an example, sponge 454 and needle array 456 can be used independently (e.g., one without the other) to hold tissue sample 468 between jaw 458A and jaw 458B.

[0097] 10 is a schematic diagram of a biopsy instrument 500 including a forceps 502 with extendable jaws 504A and 504B. The forceps 502 may include a base 506, a hinge 508, and rails 510A and 510B. The jaws 504A and 504B may include teeth 512. A tissue sample 514 may be positioned between the jaws 458A and 458B. The jaw 504A may be slidably coupled to the rail 510A so as to be displaceable in a direction Y1. Thus, the jaw 504A may be displaced a distance D1 from the center line CL (relative to an unrotated state). Similarly, the jaw 504B may be slidably coupled to the rail 510B so as to be displaceable in a direction Y2. Thus, the jaw 504B may be displaced a distance D2 from the center line CL (relative to an unrotated state).

[0098] The jaws 504A and 504B can be used to obtain a tissue sample 514, such as via actuation by control wires 448A and 448B. The jaws 504A and 504B can be moved radially outward in the direction of arrows Y1 and Y2. In an example, the jaws 504A and 504B can be moved on rails 510A and 510B with resistance from the tissue sample 514. The jaws 504A and 504B can include tracks that ride on the rails 510A and 510B. Thus, when the jaws 504A and 504B are actuated closed and a tissue sample 514 is present, the jaws 504A and 504B can move outward to accommodate the presence of the tissue sample 514. The tracks can ride on the rails 510A and 510B with an appropriate level of friction to prevent free movement between them. Thus, jaws 504A and 504B can be moved to accommodate the collection of multiple tissue samples or samples of larger size compared to jaws that are fixed at a pivot point.

[0099] 11 is a schematic diagram of a biopsy instrument 550 including a forceps 552 having a flexible jaw 554 and an opposing jaw 556. The flexible jaw 554 and the opposing jaw 556 may be connected at a hinge 558 and coupled to a base 560. The jaws 554 and 556 may include teeth 562. The flexible jaw 554 may include a deflectable wall 564. Tissue samples 566A and 566B may be positioned between the jaws 554 and 556.

[0100] Jaws 554 and 556 can be used to obtain tissue sample 556A, such as via actuation by control wires 448A and 448B. Thus, tissue sample 556A can be positioned between jaws 554 and 556. Tissue sample 556A can occupy the space between jaws 554A and 554B. However, rather than stopping the tissue collection procedure to withdraw biopsy instrument 550 and endoscope (with biopsy instrument 550 inserted therein), jaws 554 and 556 can be operated to collect a second tissue sample 556B, which can be positioned between jaws 554A and 556. The presence of tissue sample 556B can displace tissue sample 556A outward toward jaws 556. Tissue sample 566A can deflect deflectable wall 564 outward, away from hinge 558, a distance D3 from its undeflected position, creating more space between jaw 554 and jaw 556.

[0101] 12 is a block diagram illustrating an example method 600 of collecting biological material from a patient using a biopsy device and tissue retrieval device (e.g., tethered distally to an endoscope) of the present disclosure. Method 600 can involve the use of endoscopy system 400 of FIG. 8A, forceps 438 of FIG. 8B, biopsy instrument 450 of FIG. 9, biopsy instrument 500 of FIG. 10, and biopsy instrument 550 of FIG. 11, as well as other instruments, including those described herein.

[0102] In step 602, a biopsy device (e.g., forceps 438 of FIG. 8B , biopsy instrument 450 of FIG. 9 , biopsy instrument 500 of FIG. 10 , and biopsy instrument 550 of FIG. 11 ) may be inserted into endoscope 402. For example, control cables 414A and 414B may be inserted into lumen 424 of shaft 422. In an example, control cables 414A and 414B may be longer than endoscope 402 such that the proximal ends of control cables 414A and 414B with couplers 416A and 416B can extend proximally out of endoscope 402.

[0103] In step 604, the biopsy device can be attached to the endoscope and prevented from being separated from the endoscope. For example, handpiece 418 can be assembled to handpiece 426, such as by attaching couplers 420A and 420B to couplers 416A and 416B, to prevent control cables 414A and 414B from sliding out of lumen 424. In other examples, couplers 416A and 416B can be attached to handpiece 426 without the use of handpiece 418. Additionally, base 412 of biopsy device 406 can be attached to shaft 422 of endoscope 402.

[0104] In step 606, a duodenoscope may be inserted into the patient's anatomy, such as by being inserted into an opening or incision in the patient. In an example, the duodenoscope may be guided into the patient's duodenum to perform a cholangioscopy procedure. However, the tethered biopsy device of the present disclosure may also be used in other types of procedures mentioned herein (e.g., other gastrointestinal procedures and renal procedures, etc.).

[0105] In step 608, the duodenoscope may be inserted into and navigated through the patient's anatomy. For example, endoscope 14 (FIG. 1) may utilize its native imaging capabilities to guide insertion section 28 through the patient's anatomical passages. Insertion section 28 may be bent or curved using control knob 38 to facilitate turning of endoscope 14.

[0106] In step 610, an endoscope or auxiliary scope can be inserted into the duodenoscope to access anatomical structures located further into the conduit. For example, endoscope scope 402 (FIG. 8A) with biopsy device 404 attached thereto can be inserted into lumen 62 (FIG. 3C) or lumen 132 (FIG. 4) to reach another anatomical conduit that intersects the anatomical conduit reached by endoscope 14. Elevator 54 (FIG. 3C) can be used to bend or turn endoscope 402.

[0107] In step 612, the endoscope can be navigated through the anatomy. For example, the endoscope 402 can be guided from the duodenum to the common bile duct. The endoscope can be guided using the endoscope's natural steering and imaging capabilities.

[0108] In step 614, a viewing or imaging device on the auxiliary scope can be activated to view the patient's biological material. For example, imaging unit 110 can be activated to view anatomical structures within field of view 240 of lens 238. The image can be sent back to control unit 16.

[0109] In step 616, the target tissue can be viewed using the imaging unit and video display monitor. For example, the imaging unit 110 can use the lens 238 to display the target tissue on the output unit 18. The lens 238 can view the target tissue through a transparent or translucent portion of a tissue collection device (e.g., the forceps 438 of FIG. 8B , the biopsy instrument 450 of FIG. 9 , the biopsy instrument 500 of FIG. 10 , and the biopsy instrument 550 of FIG. 11 ). Light from a light source can be used to illuminate the target tissue. For example, light from the lens 239, such as that generated by the illumination unit 112, can be directed onto the target tissue. As discussed herein, various components of the tissue collection device can be configured to reflect light from the light source to enhance visibility.

[0110] In step 618, the tissue collector of the biopsy device can be navigated to a location of target tissue within the patient. For example, jaws 408A and 408B can be navigated through an anatomical conduit to target tissue 254 ( FIG. 6A ). The target tissue can include tissue that is potentially diseased or otherwise indicative of a diseased condition in the patient. Jaws 408A and 408B can be pushed, pressed, or otherwise brought into pressure contact with the target tissue. Thus, jaws 408A and 408B can be rotated about hinge 410 by activation of guide cables 414A and 414B from handpiece 418, causing jaws 408A and 408B to slice, punch, scrape, etc., one or more pieces of tissue away from the patient's anatomy. Additionally, portions of the tissue collection device can interact with light from lens 239 to enhance visibility of such portions. For example, the tissue separating components (eg, teeth or blade edges, etc.) may be reflective or luminescent to enhance their display on a video display monitor (eg, output unit 18, etc.).

[0111] In step 620, the sample tissue or biological material separated or collected from the patient in step 618 can be stored in an interior space or volume of the tissue collection device. For example, separated sample tissue 258 can be positioned in space 256. As described with reference to biopsy instrument 450 of FIG. 9 , biopsy instrument 500 of FIG. 10 , and biopsy instrument 550 of FIG. 11 , the tissue collection device can include capacity-enhancing features that facilitate the collection of large volumes of sample tissue (e.g., multiple sample tissue volumes, etc.). Sponge 454 and needle array 456 can include retention features that can operate independently or cooperatively to urge or retain the collected tissue sample within jaws 458A and 458B to prevent the collected tissue sample from falling out. Slidable rails 510A and 510B and deflectable wall 564 can include volume-increasing features that can be used to secure increasingly larger volumes of tissue within their respective jaws.

[0112] Additional tissue can be collected by the biopsy device by reapplying the tissue separator device in step 622. As more tissue pieces are collected, the newly collected pieces can push the previously collected pieces further into the tissue collection device. The previously collected pieces can then activate a volume-enhancing feature, for example, by pushing the previously collected pieces into engagement with sponge 454, pushing into needle array 456, pushing movable jaws 504A and 504B outward, and moving deflectable wall 564, etc.

[0113] In step 624, the biopsy device can be removed from the patient, such as by removal from the duodenoscope, and it can be left in place inside the anatomy. Safeguards can be put in place to ensure removal of the tissue collection device without inadvertently cutting into the patient's anatomy.

[0114] The collected sample tissue can be removed from the tissue collection device in step 626. For example, jaws 408A and 408B can be rotated away from each other to access the space between them to remove sample tissue, such as for analysis.

[0115] The duodenoscope can be removed from the patient in step 628. The patient can then be appropriately occluded or prepared for completion of the procedure.

[0116] As such, method 600 illustrates an example of a method for collecting biological material from a patient's internal passageway in a sufficiently large volume, for example, by using an optically enhanced (e.g., transparent, clear, reflective, translucent, luminescent, or scattering) tethered tissue removal device with an internal reservoir to eliminate or reduce the insertion and removal of surgical devices from the patient. Tethering the tissue removal device allows for instruments to be used that are larger than what the working channel or lumen of the endoscope can accommodate. The optical enhancement allows, for example, for the tissue removal device to be at least partially invisible to a camera and visible by a light source.

[0117] FIG. 13 is a schematic diagram of a surgical instrument 700 including a collection device 702 and laser fluorescence capabilities (e.g., lens 737, etc.). The collection device 702 can include a tissue separator 710 including forceps 750 including jaws 712A and 712B connected at a hinge 714. FIG. 13 shows the forceps 750 extending from a working channel 734 of a shaft 732 of an endoscope 730 in proximity to a target tissue 754. The components in FIG. 13 are not necessarily drawn to scale. While FIG. 13 is described with reference to an endoscope 730 and collection device 702, the laser fluorescence capabilities and other optical excitation capabilities described herein can be utilized with other scopes and surgical instruments (including colonoscopes, hysteroscopes, urethroscopes, laparoscopes, and duodenoscopes). The surgical instrument 700 can include a standalone instrument that can be used by itself with or without a motherscope (e.g., duodenoscope, etc.).

[0118] The collection device 702 can be positioned in an anatomical conduit 755 in which a target tissue 754 is located. The shaft 722 can be used to guide the separator 710 through the anatomical conduit 755 to the target tissue 754. The target tissue 754 may include a protrusion (e.g., a growth of cancerous or precancerous material). The target tissue 754 can include a dye material 757. The dye material 757 can include a fluorescent dye or another material that can emit light after absorbing excitation light.

[0119] The imaging lens 738 may include an imaging component, which may be connected to other optical components (e.g., a prism and an imaging unit (e.g., imaging unit 67 of FIG. 3B), etc.), which may be coupled to a wire 768, which may extend directly or indirectly (via the handle section 32 and / or other wires) to the control unit 16 ( FIG. 2 ). The wire 768 may be similar to the wire 68 of FIG. 3B.

[0120] The excitation lens 737 can include a first light emitter, and the first light can be emitted from the first light emitter. The lens 737 can be connected to a light transmitter 770, which can include a fiber optic cable or cable bundle or another light transmitter extending through a passageway 774 to a light source 772. The light source 772 can be connected to the control unit 16 ( FIG. 2 ) via the handle section 32 and / or other wiring or connections. Thus, light from the light source 772 can be transmitted through the light transmitter 770 to the lens 737, such that excitation light 775 is produced.

[0121] The illumination lens 739 can include a second light emitter, and a second light can be emitted from the second light emitter. The lens 739 can be connected to a light transmitter 776, which can include a fiber optic cable or cable bundle that extends to the light source 22 ( FIG. 1 ), which can extend directly or indirectly (via the handle section 32 and / or other wiring or connections) to the control unit 16 ( FIG. 2 ). The light transmitter 764 can extend through a passageway 778. Thus, light from the light source 22 can be transmitted through the light transmitter 776 to the lens 739, such that illumination light 740 is produced.

[0122] As discussed below, the combination of excitation light from lens 737 and illumination light from lens 739, as well as the optically transmissive properties (e.g., transparency) of jaws 712A and 712B, can enable better viewing of target tissue 754 with the aid of photoexcited dye material 757. Light source 772 can be configured to emit light to illuminate the tissue and excite the dye therein, facilitating better acquisition of target tissue 754 by jaws 712A and 712B and better viewing by lens 738.

[0123] Endoscope 730 can be positioned so that lens 738 faces target tissue 754. As such, target tissue 754 can be within the field of view of illumination light 740 of lens 739. The field of view of illumination light 740 is illustrated as having a particular viewing angle. However, lens 739 can be configured to have a field of view having a different angle up to and including 180 degrees.

[0124] The target tissue 754 can be within the field of view of the excitation light 775 of the lens 737. The field of view of the excitation light 775 can be up to 180 degrees. However, the field of view of the excitation light 775 can be more focused to illuminate only a smaller area of ​​the conduit 755. For example, the field of view of the light 775 can be smaller than the field of view of the light 740. The field of view of the light 775 can be configured to project on the order of the size of the tissue collection device 702 at the length over which the tissue collection device 702 is desired to operate. As such, the tissue excited by the excitation light 775 can provide a direction finder for the tissue separator 710 to extend.

[0125] The tissue collection device 702 is extended from the shaft 732, exposing the jaws 712A and 712B and allowing them to reach the target tissue 754. As such, the jaws 712A and 712B can be positioned within the illumination light 740 and the excitation light 775. As such, the jaws 712A and 712B can obstruct or impede the light 740 and the light 775 from reaching the target tissue 754. For example, the portion of the conduit 755 from which the target tissue 754 extends can become obstructed from viewing by the lens 738. As such, as described herein, the jaws 712A and 712B can be fabricated from a material that at least partially allows light waves to pass through (including clear, transparent, and translucent materials). The material of the jaws 712A and 712B can additionally include a material or substance that can be excited by the excitation light 775 or reflected by the illumination light 740 to enhance viewing by the imaging lens 738. In an example, tissue collection device 702 can be fabricated from an opaque or light-impermeable material. For example, the tissue collection device can be sized to fit through the working channel or lumen of a scope without obstructing (or with a reduced likelihood of obstructing) the view of an imaging device, thereby making transparency less desirable.

[0126] Light passing through jaws 712A and 712B may be incident on target tissue 754. Illumination light 740 may provide visible light to aid in viewing the tissue. Excitation light 775 may provide additional light to excite dye material 757. Dye material 757 may be excited by the light from lens 737 to facilitate identification and collection of target tissue 754.

[0127] The dye material 757 can include one or more surgical dyes, including fluoroscopic dyes and near-infrared dyes. In an example, the dye material 757 can include a luminescent material. In an example, the dye material 757 can comprise or include a fluorophore, which is a fluorescent chemical compound that can re-emit light when excited by light. In an example, the dye material 757 can include a blue dye (methylene blue) that can be used in cancer surgery and a fluorescent dye (e.g., indocyanine green (ICG)) that can be used in endometriosis surgery. In an example, the dye material 757 can include fluorescein (maximum excitation at 490 nm), and the light source 772 can include an argon-ion blue-green laser that emits primarily at wavelengths of 488 (blue) nm and 514 (green) nm.

[0128] [Table 1]

[0129] Table 1 lists various dyes, the relevant tissues in which they may be used, and the wavelengths for which their peak absorption is associated. As such, lasers and other light sources capable of emitting light having wavelengths around the peak absorption can be used to excite the listed dyes.

[0130] In an example, light 775 can include infrared light, near-infrared light, or ultraviolet light. In an example, light 775 can be blue light or green light. In an example, light 775 can include light having a wavelength in the range of approximately 400 to 800 nanometers (nm). Light 775 from light source 772 can provide excitation energy that is absorbed by molecules in tissue to activate a luminescent dye administered to the patient. Light source 772 can be configured as a laser or can produce light amplification by stimulated emission of radiation. In an example, laser light can be produced in the range of 358 to 405 nanometers.

[0131] The light source 772 can comprise a stand-alone module that can be coupled to the surgical instrument 700 via the light transmitter 770. As such, the light source 772 can be located remotely from the surgical instrument 700. In a further example, the light source 772 can be directly attached to the exterior of the handle section 32 (FIG. 2). The light source 772 can be removably attached to the handle section 32 via a coupler, thereby allowing for the attachment of light generators that produce different intensities or wavelengths that can enable the excitation of different types of surgical dyes, including fluoroscopic dyes and near-infrared dyes. In a further example, the light source 772 can be integrated into the handle section 32, eliminating the use of a connector. In a further example, the light source 772 can be integrated into the control unit 16, and the light transmitter 770 and cable section 34 (FIG. 1) can be included in a common cable bundle.

[0132] The optical transmitter 770 may connect the optical source 772 with the distal end portion of the shaft 732, such as at the lens 737. The optical transmitter 770 may include one or more cables or conductors for conducting, communicating, or transmitting light waves. In an example, the optical transmitter 770 may include a fiber optic cable. In an example, the fiber optic cable may include glass and plastic fibers coated with one or more protective and reflective coatings. The optical transmitter 770 may be disposed in the passageway 774. In an example, the optical transmitter 770 may be embedded in the shaft 732 or positioned in a channel provided therein. In an example, the optical transmitter 770 may be positioned outside the shaft 732 and secured thereto via a sheath. In an example, the optical transmitter 770 may be adhered or glued to the shaft 732, either internally or externally.

[0133] The lens 737 can be positioned at or near the distal end of the transmitter 770. The lens 737 can be coupled to the optical transmitter 770 by any suitable means. In an example, the lens 737 can include a lens for collecting and focusing light waves from the optical transmitter 770. The lens 737 can include a glass or plastic body of a transparent material. However, in additional examples, a separate optical emitter is not used and the optical transmitter 770 can include an edge-emitting fiber such that the distal or terminal end of the optical transmitter 770 can include the optical emitter.

[0134] In an example, light 740 may include incandescent light from a light bulb or directional light from a light emitting diode. In an example, light 740 may be white light or yellow light. In an example, light 740 may include light having a wavelength in the range of approximately 400 to 700 nanometers (nm). Light 740 is visible to the naked eye and may facilitate imaging lens 738 capturing an image of conduit 755, which may be seen in output unit 18 (FIG. 1).

[0135] With light 740 illuminating conduit 755 and light 775 exciting dye material 757, tissue separator 710 can be engaged with target tissue 754. Jaws 712A and 712B can be rotated away from each other at hinge 714, and tissue collection device 702 can be moved axially toward sample tissue 758. Jaws 712A and 712B can be rotated toward each other to engage target tissue 754. Tissue collection device 702 can be reciprocated back and forth along the axis of shaft 722 to collect sample tissue 758. Teeth 713 can be used to cut, saw, tear, or peel a portion of target tissue 754 away from the patient's anatomy. In an example, only one of jaws 712A and 712B can be configured to rotate. As noted, the excited dye material 757 can provide a target, and the jaws 712A and 712B can be navigated to the target.

[0136] Teeth 713 can be fabricated from the edges of jaws 712A and 712B. In an example, teeth 713 can include extensions of the material of jaws 712A and 712B. In such an example, teeth 713 and both jaws 712A and 712B can be fabricated from a rigid material such as plastic or metal. In an example, jaws 712A and 712B can be fabricated from Gorilla Glass®, available from Corning, or other chemically strengthened glass (e.g., alkali aluminosilicate sheet glass, etc.). In an example, jaws 712A and 712B can be fabricated from molded polycarbonate.

[0137] As discussed above, components or portions of the tissue collection device 702 can be made from optically enhanced materials. In an example, the jaws 712A and 712B can be made from a translucent or transparent material, which can allow light waves to travel therethrough, thereby allowing the lens 738 to “see through” the jaws 712A and 712B. A transparent material can allow the lens 738 to see the natural coloration of the target tissue 754. A translucent material can be configured to allow the lens 738 to view the target tissue 754 in a filtered manner. As such, the jaws 712A and 712B can be translucently colored with different colors to enhance the visibility of certain tissue types or diminish the visibility of other tissue types.

[0138] However, to maintain control of tissue collection device 702 (e.g., to maintain accurate use of teeth 713), portions of tissue collection device 702 can be opaque, reflective, or translucent. In particular, teeth 713 can be made from an opaque, reflective, or translucent material or can have a coating applied to it that has those properties. In an example, teeth 713 can be opaque so that they can be easily viewed through lens 738. In an additional example, teeth 713 can be configured to optically interact with light from lens 739. For example, teeth 713 can have a reflective coating applied to them (e.g., a coating of reflective particles or titanium oxide granules, etc.). Thus, light from lens 739 can bounce back to lens 738. In an additional example, teeth 713 can be fluorescent so that they brighten when engaged by a particular type of light (e.g., light from lens 737, etc.). Thus, light from lens 739 can cause lens 738 to view teeth 713 at a particular wavelength that is more discriminative to conduit 755. In an example, only some of teeth 713 can be reflective or fluorescent.

[0139] In view of the foregoing, the use of an optically enhanced tissue collection device can facilitate viewing of the target tissue 754 through the jaws 712A and 712B, viewing of the sample tissue 758 within the jaws 712A and 712B, and viewing of the laceration where the sample tissue 758 has been removed from the target tissue 754. As such, the endoscope 730 can be used to view the internal tissue layers within the laceration and potentially diagnose conditions of that tissue.

[0140] In additional examples, teeth 713 and jaws 712A and 712B can be configured similarly to teeth 213 and jaws 212A and 212B as described with reference to Figures 6A and 6B, and the devices shown and described with reference to Figures 9, 10, and 11. For example, teeth 713 can be oriented in a forward or rearward orientation relative to the interior of jaws 712A and 712B, and jaws 712A and 712B can include features to facilitate increasing the volume or holding capacity of collected tissue samples, such as by being expandable.

[0141] FIG. 14 is a block diagram illustrating an example method 800 of collecting biological material from a patient using the tissue collection and retrieval devices of the present disclosure (e.g., including light-emitting capabilities for activating a light-emitting material), as described herein. Method 800 can include the use of endoscopy system 700 of FIG. 13 as well as other instruments, including those described herein. In an example, surgical instruments, such as cutting forceps with cauterizing and cutting capabilities, in which the light-emitting capabilities and light-emitting materials of the present disclosure can be utilized, are described in U.S. Patent Application No. 17 / 100,025, entitled "Surgical instruments with integrated lighting systems," by Murdeshwar, which is incorporated herein by reference in its entirety. Method 800 of FIG. 14 is described with reference to FIG. 13 unless specifically stated otherwise.

[0142] In step 802, a dye may be administered to the patient. The dye may be ingested or administered intravenously. The dye may include any type of dye or dye material used for surgical procedures as discussed herein. The dye or other material may be configured to absorb light of a first wavelength from a light source and emit light of a second wavelength. As discussed herein, the dye may include fluoroscopic materials, luminescent materials, and the like. The dye may be metabolized or otherwise injected or absorbed into the patient's tissue, including by the tissue to be targeted by the surgeon for relief (e.g., target tissue 754). Tissues of the uterus, bladder, ovaries, and other locations and organs (e.g., fallopian tubes, rectum, etc.) may metabolize the dye. The target tissue may be cancerous tissue or endometrial tissue. Step 800 may alternatively be performed pre-operatively or intra-operatively.

[0143] In step 804, a duodenoscope (e.g., scope 14 of FIG. 1 ) may be inserted into the patient's anatomy, such as by being inserted into an opening or incision in the patient. In an example, the duodenoscope may be guided into the patient's duodenum to perform a cholangioscopy procedure. However, the present disclosure may be utilized with other devices and procedures used in other types of procedures mentioned herein (e.g., other gastrointestinal procedures, renal procedures, cancer treatment procedures, etc.). The duodenoscope may be inserted into and navigated through the patient's anatomy. For example, the endoscope 14 ( FIG. 1 ) may utilize its inherent imaging capabilities to guide the insertion section 28 through the patient's anatomical canals. The insertion section 28 may be bent or curved using the control knob 38 to facilitate turning the endoscope 14.

[0144] In step 806, another scope can be inserted into the duodenoscope. An endoscope or auxiliary scope can be inserted into the duodenoscope to access anatomical structures located further into the conduit. For example, endoscope 730, along with tissue collection device 702 (FIG. 13), can be inserted into lumen 62 (FIG. 3C) or lumen 132 (FIG. 4) to reach another anatomical conduit that intersects the anatomical conduit reached by endoscope 14. Elevator 54 (FIG. 3C) can be used to bend or turn endoscope 402.

[0145] In step 808, illumination light 740 can be emitted. For example, a light source capable of emitting visible light can be used to provide illumination of anatomical structures distal to the auxiliary scope. Illumination unit 112 (FIG. 4) can be activated by a switch on handle section 32 (FIG. 2) to illuminate anatomical structures distal to forceps 750. Thus, visible light can be emitted to aid in visualization of imaging unit 110 (FIG. 4). For example, light from lens 739, as generated by illumination unit 112, can be directed onto target tissue.

[0146] In step 810, a viewing or imaging device on the auxiliary scope can be activated to view the patient's biological material. For example, imaging unit 110 can be activated to view anatomical structures within the field of view of illumination light 740 of lens 738. The image can be sent back to control unit 16 (FIG. 2). Target tissue 754 and surrounding tissue can be viewed using the imaging unit and a video display monitor. For example, imaging unit 110 can use lens 738 to display the target tissue on output unit 18 (FIG. 1).

[0147] In step 812, the endoscope 730 can be navigated through the anatomy. For example, the endoscope 730 can be guided from the duodenum to the common bile duct. The endoscope 730 can be guided using the endoscope's natural steering and imaging capabilities. Once the auxiliary scope is in the general area of ​​the anatomy where the target tissue is located, an activating light 775 can be emitted to reach a specific location of the target tissue.

[0148] In step 814, excitation light 775 can be emitted. Light source 772 can be capable of emitting light at a wavelength compatible with the dye administered in step 802. Light 775 can be used to excite dye material 757. Light source 772 can be activated by a switch on handle section 32 ( FIG. 2 ) and interact with anatomical structures distal to forceps 750. Thus, excitation light 775 can be emitted to aid in identifying target tissue 754. For example, light from lens 737, as generated by light source 772, can be directed onto target tissue 754.

[0149] In step 816, target tissue 754 can be viewed through tissue collection device 702. Lens 738 allows the target tissue to be viewed through a transparent or translucent portion of tissue collection device 702 (such as, for example, jaws 712A and 712B of forceps 750 in FIG. 13 ). At any time during the procedure, visible wavelength light from lens 738 can pass through collection device 702. Light 740 and light 775 can be turned on and off as needed by the user to use neither light 740 nor light 775, to use both of them, or to use only one of them.

[0150] In step 818, the portion of the anatomical structure where the dye of step 802 has been metabolized can interact with light from lens 737. The light can additionally be light of a wavelength sufficient to excite (e.g., fluoresce) the dye (e.g., near-infrared (NIR) light, etc.). NIR light can be used to excite indocyanine green in endometriosis surgery. NIR light is typically located in the near-infrared region of the electromagnetic spectrum, from approximately 780 nm to approximately 2500 nm. Indocyanine green dye can concentrate in areas rich in blood vessels (e.g., endometrial tissue). Additionally, the light and dye combinations listed in Table 1 can be utilized together. Light 775 can excite the metabolized dye into the tissue of duct 775. In particular, damaged, diseased, or other undesirable tissue can metabolize the dye, allowing light 775 to more easily distinguish the tissue from neighboring tissue. The excited dye can be viewed through a camera lens 738 connected to imaging unit 110 (FIG. 4). Video from lens 738 can be viewed through an eyepiece attached to endoscope 730 or at output unit 18 (FIG. 1), which can include a video monitor. For example, target tissue 754 can include dye material 757, which indicates the target tissue to be removed.

[0151] In step 820, portions of tissue collection device 702 can interact with light 775 from lens 239 to enhance visibility of such portions. As discussed herein, various components of tissue collection device 702 can be configured to reflect light from light source 772 to enhance visibility. For example, tissue separation components (e.g., tines 712A and 712B or blade edges) can be reflective or luminescent to enhance display on a video display monitor (e.g., output unit 18 (FIG. 1)).

[0152] In step 822, the tissue separator 710 of the surgical instrument 700 can be used to collect target tissue 754 within the patient. For example, the jaws 712A and 712B can be navigated through an anatomical conduit 755 to the target tissue 754. The target tissue 754 can include tissue that is potentially diseased or otherwise indicative of a diseased condition in the patient. The jaws 712A and 712B can be pushed, pressed, or otherwise brought into pressure contact with the target tissue 754. As such, the jaws 712A and 712B can be rotated about the hinge 714 from the handle section 32 (FIG. 2), causing the jaws 712A and 712B to slice, punch, scrape, etc., one or more pieces of tissue away from the patient's anatomy.

[0153] The sample tissue or biological material separated or collected from the patient in step 822 can be stored in a space 756 or internal volume inside the tissue collection device 702. For example, separated sample tissue 758 can be positioned in space 756. As described with reference to biopsy instrument 450 of FIG. 9 , biopsy instrument 500 of FIG. 10 , and biopsy instrument 550 of FIG. 11 , tissue collection device 702 can include capacity-enhancing features that facilitate the collection of large volumes of sample tissue (e.g., multiple sample tissue volumes, etc.). Sponge 454 and needle array 456 ( FIG. 9 ) can include retention features that can operate independently or cooperatively to urge or retain the collected tissue sample within jaws 712A and 712B to prevent the collected tissue sample from falling out. Slidable rails 510A and 510B (FIG. 10) and deflectable wall 564 (FIG. 11) can include volume-increasing features that can be used to secure increasingly larger volumes of tissue within their respective jaws 712A and 712B.

[0154] Additional tissue can be collected by the biopsy device by reapplying tissue separator 710. As more tissue pieces are collected, the newly collected pieces can push the previously collected pieces further into tissue collection device 702. The previously collected pieces can then activate a volume-enhancing feature, for example, by pushing the previously collected pieces into engagement with sponge 454, pushing into needle array 456, pushing movable jaws 504A and 504B outward, and moving deflectable wall 564, etc.

[0155] In step 824, tissue collection device 702 can be removed from the patient, such as by removal from a duodenoscope, and it can be left in place inside the anatomy. Safeguards can be put in place to ensure removal of the tissue collection device without inadvertently cutting the patient's anatomy. Tissue collection device 702 can be reinserted, if desired, to collect additional tissue samples.

[0156] In step 826, the collected sample tissue can be removed from the tissue collection device 702. For example, jaws 712A and 712B can be rotated away from each other at hinge 714 to access space 756 therebetween to remove sample tissue, such as for analysis.

[0157] The duodenoscope can be removed from the patient in step 828. The patient can then be appropriately occluded or prepared for completion of the procedure.

[0158] As such, method 800 illustrates an example of a method for collecting biological material from an internal passageway of a patient using an activation light integrated into a scope. The activation light can be used to excite a luminescent dye in the tissue. The luminescent dye can be previously administered or metabolized by the patient, so that the dye is in the target tissue during the scoping procedure. The excitation light from the scope can, under appropriate conditions, reach the stained target tissue by passing through a tissue collection device. For example, the tissue collection device can be made of a material that allows some, most, or all light to pass through while selectively allowing illumination light to pass or be reflected. Thus, the tissue collection device can be optically enhanced (e.g., transparent, clear, reflective, translucent, luminescent, or scattering) to, for example, allow the tissue collection device to be at least partially invisible to a camera and visible to a light source or partially highly visible to a camera. As such, the excitation light can pass through the tissue collection device while the tissue collection device is being used to collect a target tissue sample. The present application includes several features that can be used to increase the likelihood of successful intervention (e.g., successfully removing substantially all of the diseased tissue, or collecting a sample size large enough that biopsies and other subsequent procedures can be performed without having to reinsert forceps or another instrument and without having to perform subsequent procedures).For example, the present disclosure can combine the ability to collect large sample sizes (FIGS. 8A-12) with the ability to specifically identify target tissue through a combination of lasers and dyes (FIGS. 13 and 14), helping to ensure that a sufficiently large sample of the desired (properly identified) tissue is collected, thereby reducing or eliminating the need to reinsert the instrument to collect a second sample or to perform additional procedures to collect further tissue or perform additional treatments.

[0159] 15 is a block diagram illustrating an example method 900 of collecting biological material from a patient using a tissue retrieval device (e.g., optically enhanced, etc.) of the present disclosure. Method 900 can involve the use of surgical instrument 200 of FIGS. 5A-6B and tissue retrieval device 300 of FIG. 7A, as well as other instruments.

[0160] In step 902, an endoscope may be inserted into and navigated through a patient's anatomy. For example, endoscope 14 (FIG. 1) may utilize its native imaging capabilities to guide insertion section 28 through the patient's anatomical passages. Insertion section 28 may be bent or curved using control knob 38 to facilitate turning of endoscope 14.

[0161] In step 904, an auxiliary scope can be inserted into the endoscope to access anatomical structures located further into the conduit. For example, auxiliary scope 134 (FIG. 4) can be inserted into lumen 62 (FIG. 3C) or lumen 132 (FIG. 4) to reach another anatomical conduit that intersects the anatomical conduit reached by endoscope 14. Elevator 54 (FIG. 3C) can be used to bend or turn auxiliary scope 134.

[0162] In step 906, a tissue retrieval device can be inserted into the auxiliary scope to reach the target tissue distal to the auxiliary scope. For example, surgical instrument 200 (FIG. 5A) can be inserted such that tissue collection device 204 extends beyond the distal end of auxiliary scope 134.

[0163] In step 908, a tissue collection device can be navigated to a target tissue location within the patient. For example, tissue collection device 204 can be navigated through an anatomical conduit to target tissue 254 (FIG. 6A). The target tissue can include tissue that is potentially diseased or otherwise indicative of a diseased condition in the patient.

[0164] In step 910, a viewing device on the auxiliary scope can be activated to view the patient's biological material. For example, imaging unit 110 can be activated to view anatomical structures within field of view 240 of lens 238.

[0165] In step 912, the target tissue can be viewed using the imaging unit and video display monitor. For example, the imaging unit 110 can use the lens 238 to display the target tissue on the output unit 18. The lens 238 can view the target tissue through a transparent or translucent portion of the tissue collection device. Light from a light source can be used to illuminate the target tissue. For example, light from the lens 239, such as generated by the illumination unit 112, can be directed onto the target tissue.

[0166] In step 914, the tissue collection device can be pushed, pressed, or otherwise brought into pressure contact with the target tissue. Thus, the tissue collection device 204 can be axially reciprocated or rotated, causing the blade 266 to slice, punch, scrape, or the like, one or more pieces of tissue away from the patient's anatomy. Moreover, portions of the tissue collection device can interact with light from the lens 239 to enhance the visibility of such portions. For example, tissue separation components (e.g., teeth or blade edges) can be reflective or luminescent to enhance display on a video display monitor (e.g., output unit 18, etc.).

[0167] In step 916, the sample tissue or biological material separated or collected from the patient in step 412 can be stored in a space inside the tissue collection device. For example, as the tissue collection device 204 is manipulated or rotated back and forth, the separated sample tissue 258 can be positioned in the space 256.

[0168] In step 918, the retrieved and stored tissue can be viewed in the container of the tissue collection device using the imaging unit and video display monitor. For example, the imaging unit 110 can use the lens 238 to display the target tissue on the output unit 18. The lens 238 can view the stored tissue in a transparent or translucent portion of the tissue collection device. Light from a light source can be used to illuminate the target tissue. For example, light from the lens 239, such as generated by the illumination unit 112, can be directed onto the target tissue.

[0169] In step 920, the tissue collection device can be removed from the patient, such as by removal from an auxiliary scope, and it can be left in place inside the anatomy. Safeguards can be put in place to ensure removal of the tissue collection device without inadvertently cutting the patient's anatomy.

[0170] The collected sample tissue can be removed from the tissue collection device in step 922. For example, jaws 212A and 212B can be rotated away from one another to access space 256 and remove sample tissue 258, such as for analysis.

[0171] Thereafter, the method 900 may return to step 908 or may continue to step 920 .

[0172] At step 924, the tissue collection device can be reinserted. From step 920, steps 908 through 918 can be repeated as many times as desired to achieve an appropriate amount of sample tissue (e.g., an amount sufficient to perform laboratory tests to confirm a diagnosis with a high level of certainty). Note that the present disclosure is directed to systems and methods that reduce or eliminate the need to reinsert the tissue collection device. However, in some cases, it may be desirable to do so to collect additional sample material from the same site or to collect sample material from a different site.

[0173] In step 926, the auxiliary scope can be removed from the endoscope.

[0174] In step 928, the endoscope can be removed from the patient.

[0175] As such, method 900 illustrates an example of a method for collecting biological material from an internal passageway of a patient in a sufficiently large quantity, for example, by using an optically enhanced (e.g., transparent, clear, reflective, translucent, luminescent, or scattering) tissue removal device with an internal reservoir to eliminate or reduce the insertion and removal of surgical devices from the patient. The optical enhancement allows, for example, the tissue removal device to be at least partially invisible to a camera and visible to a light source.

[0176] Various notes and examples Optically enhanced biological material collection device for endoscopes - Patent Application 20070122999 Example 1 may include or employ subject matter such as a tissue separation device, the tissue separation device including an elongated body including a proximal end portion and a distal end portion, and a tissue separator coupled to the distal end portion, the tissue separator configured to engage sample tissue for collection, the tissue separator being at least partially made from a material that allows light to pass through the tissue separator.

[0177] Example 2 may include, or may optionally be combined with the subject matter of Example 1, an endoscope including an elongate shaft having a first lumen, an elongate body portion capable of being disposed within the first lumen, and a viewing device configured to view a tissue separator extended from the first lumen by the elongate body portion.

[0178] Example 3 can include the feature of a viewing device positioned to view through the tissue separator, or can optionally be combined with the subject matter of one or any combination of Examples 1 or 2 and optionally include the above features.

[0179] Example 4 can include the feature that the endoscope further includes a light emitter, or can optionally be combined with the subject matter of one or any combination of Examples 1 to 3 and optionally include the above features.

[0180] Example 5 can include a tissue separator including forceps, or can optionally be combined with the subject matter of one or any combination of Examples 1 to 4 and optionally include the tissue separator.

[0181] Example 6 may include a forceps including a first jaw pivotally connected to an elongated body and a plurality of tines extending from the first jaw, or may optionally be combined with the subject matter of one or any combination of Examples 1 to 5 and optionally include the forceps described above.

[0182] Example 7 can include a plurality of teeth made from a fluorescent material, or can optionally be combined with the subject matter of one or any combination of Examples 1 to 6, and can optionally include the plurality of teeth.

[0183] Example 8 can include a plurality of teeth made from a reflective material, or can optionally be combined with the subject matter of one or any combination of Examples 1 to 7, and can optionally include the plurality of teeth.

[0184] Example 9 can include a first jaw shaped to form an internal volume, or can optionally be combined with the subject matter of one or any combination of Examples 1 to 8, and can optionally include the first jaw.

[0185] Example 10 can include the feature that the material of the first jaw that forms the interior volume is flexible, or can optionally be combined with the subject matter of one or any combination of Examples 1 to 9 and optionally include the above features.

[0186] Example 11 can include an opposing jaw disposed opposite the first jaw, or can optionally be combined with the subject matter of one or any combination of Examples 1 to 10, and can optionally include the opposing jaws.

[0187] Example 12 can include a tissue separator including an auger, or can optionally be combined with the subject matter of one or any combination of Examples 1 to 11, and can optionally include the tissue separator.

[0188] Example 13 may include an auger including a cone-shaped body, a thread extending around the cone-shaped body, and a passageway extending into the cone-shaped body, or may optionally include the above auger in combination with the subject matter of one or any combination of Examples 1 through 12. Example 14 may include a thread fabricated from a reflective or translucent material, or may optionally include the above thread in combination with the subject matter of one or any combination of Examples 1 through 13.

[0189] Example 15 can include a passageway with a sharpened edge, or can optionally be combined with the subject matter of one or any combination of Examples 1 to 14, and can optionally include the passageway.

[0190] Example 16 can include a passageway made from a reflective or translucent material, or can optionally be combined with the subject matter of one or any combination of Examples 1 to 15 and optionally include the passageway.

[0191] Example 17 can include a tissue separator including a punch, or can optionally be combined with the subject matter of one or any combination of Examples 1 to 16, and can optionally include the tissue separator.

[0192] Example 18 can include a tissue separator made from clear polycarbonate or glass, or can optionally be combined with the subject matter of one or any combination of Examples 1 to 17 and optionally include the tissue separator.

[0193] Example 19 can include a tissue separator including a tissue removal device having reflective, translucent, or transparent properties, or can optionally be combined with the subject matter of one or any combination of Examples 1 to 18 and optionally include the tissue separator.

[0194] Example 20 can include the feature that the tissue separator includes an internal volume for storing separated tissue, or can optionally be combined with the subject matter of one or any combination of Examples 1 to 19 and optionally include the above features.

[0195] Example 21 includes or may use subject matter such as a method for collecting biological material using a tissue collection device, which may include inserting the tissue collection device into a patient's anatomical structure, guiding a tissue collector of the tissue collection device to a target tissue, viewing the target tissue through the tissue collector, and collecting biological material from the target tissue with the tissue collection device.

[0196] Example 22 can include a step of viewing the target tissue through a tissue collector by viewing an image of the target tissue with a video camera, or can optionally be combined with the subject matter of Example 21 and optionally include the above steps.

[0197] Example 23 can include a step of viewing the target tissue through the tissue collector by viewing the target tissue beyond the tissue collector, or can optionally be combined with the subject matter of one or any combination of Example 21 or Example 22 and optionally include the above steps.

[0198] Example 24 can include a step of viewing the target tissue through a tissue collector by viewing the target tissue in the tissue collector, or can optionally be combined with the subject matter of one or any combination of Examples 21 to 23 and optionally include the above steps.

[0199] Example 25 can include the steps of penetrating the surface of the target tissue with a tissue collector and viewing the newly exposed tissue within the penetrated surface, or can optionally be combined with the subject matter of one or any combination of Examples 21 to 24 and optionally include the above steps.

[0200] Example 26 may include a step of collecting biological material from the target tissue with a tissue collection device by operating forceps to sever a portion of the target tissue, or may optionally be combined with the subject matter of one or any combination of Examples 21 to 25 and optionally include the above steps.

[0201] Example 27 may include a step of collecting biological material from the target tissue with a tissue collection device by drilling a tissue punch into the target tissue, or may optionally be combined with the subject matter of one or any combination of Examples 21 to 26 and optionally include the above steps.

[0202] Example 28 may include a step of collecting biological material from the target tissue with a tissue collection device by advancing an auger into the target tissue, or may optionally be combined with the subject matter of one or any combination of Examples 21 to 27 and optionally include the above steps.

[0203] Example 29 can include a step of illuminating the tissue collection device with a light emitter, or can optionally be combined with the subject matter of one or any combination of Examples 21 to 28 and optionally include the above steps.

[0204] Example 30 may include a step of fluorescing the cutting edge of the tissue collection device, or may optionally be combined with the subject matter of one or any combination of Examples 21 to 29, and may optionally include the above steps.

[0205] Example 31 may include a step of reflecting light by the cutting edge of the tissue retrieval device, or may optionally be combined with the subject matter of one or any combination of Examples 21 to 29 and optionally include the above steps.

[0206] Example 32 can include a step of bending the tissue collection device to allow the cutting edge of the tissue collection device to engage the tissue, or can optionally be combined with the subject matter of one or any combination of Examples 21 to 31 and optionally include the above step.

[0207] Example 33 may include a step of storing the tissue in a tissue collection device, or may optionally be combined with the subject matter of one or any combination of Examples 21 to 32, and may optionally include the above steps.

[0208] Example 34 may include a step of viewing the target tissue through the tissue collector by viewing the target tissue through a translucent material of the tissue collector, or may optionally be combined with the subject matter of one or any combination of Examples 21 to 23 and optionally include the above steps.

[0209] Example 35 may include the steps of inserting an endoscope including a first longitudinal passage into a patient's anatomical structure, inserting an auxiliary scope including a second longitudinal passage into the first longitudinal passage, and inserting a tissue retrieval device into the second longitudinal passage to reach the target tissue, or may optionally be combined with the subject matter of one or any combination of Examples 21 to 34 and may optionally include the above steps.

[0210] Example 36 may include or be capable of using subject matter such as a surgical instrument, which may include an endoscope and a tissue retrieval device, the endoscope including an insertion shaft extending from a proximal end to a distal end, a working channel extending at least partially through the insertion shaft, and an imaging system coupled to the insertion shaft, the imaging system having a field of view that projects distally of the working channel, the tissue retrieval device including an elongate shaft positionable within the working channel and a tissue collection device, the elongate shaft extending along an axis and configured for insertion into an anatomical structure, the tissue collection device coupled to the elongate shaft and configured to separate tissue from the anatomical structure, the tissue collection device being optically enhanced to interact with the field of view of the imaging system.

[0211] Example 37 can include a tissue collection device configured to be invisible to the imaging system, or can optionally be combined with the subject matter of Example 36 and optionally include the tissue collection device described above.

[0212] Example 38 may include a tissue collection device fabricated from a translucent material, or may optionally be combined with the subject matter of one or any combination of Examples 36 or 37, and may optionally include the tissue collection device.

[0213] Example 39 can include a tissue collection device made from a transparent material, or can optionally be combined with the subject matter of one or any combination of Examples 36 to 38, and can optionally include the tissue collection device.

[0214] Example 40 may include a tissue collection device configured to magnify an image acquired by the imaging system, or may optionally be combined with the subject matter of one or any combination of Examples 36 to 39, and may optionally include the tissue collection device.

[0215] Example 41 may include a tissue collection device including a tissue separator device configured to be highlighted by an imaging system, or may optionally be combined with the subject matter of one or any combination of Examples 36 to 40, and may optionally include the tissue collection device described above.

[0216] Example 42 can include the feature that the tissue separator device is made from a reflective material, or can optionally be combined with the subject matter of one or any combination of Examples 36 to 41 and optionally include the above features.

[0217] Example 43 may include the feature that the tissue collection device is made from a translucent material, or may optionally be combined with the subject matter of one or any combination of Examples 36 to 42 and optionally include the above features.

[0218] Tethered biological material collection device for endoscopy - Patent Application 20070122999 Example 1 is a biopsy instrument comprising a tissue separator device and an elongated control element, the tissue separator device comprising a base; a tissue separator mounted to the base; and an actuation mechanism coupled to the tissue separator, the elongated control element coupled to the actuation mechanism for manipulating the tissue separator, the tissue separator being at least partially made from a material capable of transmitting light.

[0219] In Example 2, the subject matter of Example 1 optionally includes an endoscope including an elongate shaft having a first lumen, wherein an elongate control element can be disposed within the first lumen; and a viewing device configured to view a tissue separator device distal to the first lumen through the elongate body.

[0220] In Example 3, the subject matter of Example 2 optionally includes the feature that the first lumen extends along the longitudinal axis and has a first height extending transversely to the longitudinal axis; and the tissue separator has a second height greater than the first height.

[0221] In Example 4, the subject matter of any one or more of Examples 2-3 optionally includes the feature that the base has a third height greater than the first height.

[0222] In Example 5, the subject matter of any one or more of Examples 2-4 optionally includes the feature that the base is connectable to an elongate shaft.

[0223] In Example 6, the subject matter of any one or more of Examples 2-5 optionally includes the feature that the elongate control element is longer than the endoscope lumen.

[0224] In Example 7, the subject matter of any one or more of Examples 1-6 optionally includes a quick connect coupling at a proximal end of the elongate control member.

[0225] In Example 8, the subject matter of Example 7 optionally includes a handpiece connectable to the quick connect coupling, the handpiece configured to activate the actuation mechanism via an elongated control element.

[0226] In Example 9, the subject matter of any one or more of Examples 1-8 optionally includes the feature that the tissue separator includes forceps, the forceps including a first jaw; a second jaw; and a hinge, and at least one of the first and second jaws is configured to articulate about the hinge between an open position and a closed position.

[0227] In Example 10, the subject matter of Example 9 optionally includes the feature that the actuation mechanism includes a lever extending from at least one of the first and second jaws configured to articulate between the open and closed positions.

[0228] In Example 11, the subject matter of any one or more of Examples 9-10 optionally includes the feature that the forceps include a capacity-enhancing feature configured to enable the forceps to hold multiple tissue samples.

[0229] In Example 12, the subject matter of Example 11 optionally includes a feature where the volume-enhancing feature includes a tissue biasing device configured to immobilize a piece of tissue held between the first jaw and the second jaw in the open position.

[0230] In Example 13, the subject matter of Example 12 optionally includes the feature that the tissue biasing device includes: a sponge positioned on the first jaw; and a needle array positioned on the second jaw, the needle array positioned to penetrate the sponge when the first and second jaws are in a closed position.

[0231] In Example 14, the subject matter of any one or more of Examples 12-13 optionally includes a feature where the volume-enhancing feature includes a volume-increasing feature configured to increase an internal volume of at least one of the first and second jaws.

[0232] In Example 15, the subject matter of Example 14 optionally includes the feature where the volume-increasing feature includes a feature where at least one of the first jaw and the second jaw is configured to translate at the hinge in an opposite direction to the other of the first and second jaw to increase the space between the first jaw and the second jaw.

[0233] In Example 16, the subject matter of any one or more of Examples 14-15 optionally includes the feature where the capacity-increasing feature includes the feature where at least one of the first jaw and the second jaw is configured with a flexible wall portion to increase the space between the first jaw and the second jaw.

[0234] In Example 17, the subject matter of any one or more of Examples 9-16 optionally includes the feature that at least one of the first jaw and the second jaw is at least partially fabricated from a transparent material.

[0235] In Example 18, the subject matter of any one or more of Examples 1-17 optionally includes the feature where the tissue separator includes an auger including a cone-shaped body; a threaded portion extending around the cone-shaped body; and a passageway extending into the cone-shaped body.

[0236] In Example 19, the subject matter of any one or more of Examples 1-18 optionally includes the feature that the elongate control element includes a flexible pull wire.

[0237] In Example 20, the subject matter of any one or more of Examples 1-19 optionally includes a biasing element for the actuation mechanism to bias the tissue separator into position.

[0238] Example 21 is a method for collecting biological material using a biopsy device, the method including the steps of: anchoring the biopsy device to a distal end portion of an endoscope; inserting the endoscope equipped with the biopsy device into an anatomical structure of a patient; guiding the biopsy device to a target tissue site; viewing the target tissue through the biopsy device; and collecting biological material from the target tissue site with the biopsy device.

[0239] In Example 22, the subject matter of Example 21 optionally includes the feature where guiding the biopsy instrument to the target tissue site includes viewing the anatomical structure through the biopsy instrument.

[0240] In Example 23, the subject matter of any one or more of Examples 21-22 optionally includes the feature where viewing the target tissue through the biopsy instrument includes viewing an image of the target tissue site with a video camera.

[0241] In Example 24, the subject matter of any one or more of Examples 21-23 optionally includes a feature where anchoring the biopsy instrument to the distal end portion of the endoscope includes inserting an elongate control member from the distal end of the endoscope into a lumen of the endoscope.

[0242] In Example 25, the subject matter of Example 24 optionally includes the feature that anchoring the biopsy instrument to the distal end portion of the endoscope includes engaging a base of the biopsy instrument with the distal end of the endoscope.

[0243] In Example 26, the subject matter of any one or more of Examples 24-25 optionally includes attaching the control device to an elongate control member at a proximal end portion of the endoscope.

[0244] In Example 27, the subject matter of any one or more of Examples 21-26 optionally includes a feature where collecting biological material from the target tissue with the biopsy instrument includes operating forceps to sever a portion of the target tissue.

[0245] In Example 28, the subject matter of Example 27 optionally includes the feature that collecting biological material from the target tissue with the biopsy instrument includes retaining the biological material within the forceps with a tissue biasing device.

[0246] In Example 29, the subject matter of Example 28 optionally includes the feature where retaining the biological material in the forceps with the tissue biasing device further includes perforating the collected tissue with the tines.

[0247] In Example 30, the subject matter of any one or more of Examples 27-29 optionally includes a feature where collecting biological material from the target tissue with the biopsy instrument includes increasing the volume of the forceps with a volume increasing feature.

[0248] In Example 31, the subject matter of Example 30 optionally includes the feature where increasing the capacity of the forceps with the capacity increasing feature includes sliding the jaws of the forceps away from the pivot point to increase the distance from the opposing jaw.

[0249] In Example 32, the subject matter of any one or more of Examples 30-31 optionally includes a feature where increasing the volume of the forceps via a volume-increasing feature includes bending walls of the jaws of the forceps to increase an internal volume of the jaws.

[0250] In Example 33, the subject matter of any one or more of Examples 21-32 optionally includes obtaining multiple tissue samples from the target tissue with a biopsy instrument prior to withdrawing the endoscope from the anatomical structure.

[0251] Translucent biopsy device with laser fluorescence capabilities Example 1 is a surgical instrument comprising: a scope; and a tissue retrieval device, the scope including an elongate body extending from a proximal end portion to a distal end portion; a working channel extending at least partially through the elongate body; an imaging component coupled to the elongate body, the imaging component having a field of view that projects distal to the working channel; and a first light emitter configured to project light from the elongate body at a first wavelength suitable for exciting a light-emitting material, the tissue retrieval device including an elongate shaft positionable within the working channel, the elongate shaft extending along an axis and configured for insertion into an anatomical structure; and a tissue collection device coupled to the elongate shaft and configured to separate tissue from the anatomical structure.

[0252] In Example 2, the subject matter of Example 1 optionally includes the feature that the imaging component is positioned to view through the tissue collection device.

[0253] In Example 3, the subject matter of any one or more of Examples 1-2 optionally includes the feature that the first light emitter is configured to fluoresce the fluorophore.

[0254] In Example 4, the subject matter of any one or more of Examples 1-3 optionally includes the feature that the first light emitter includes a laser. In Example 5, the subject matter of any one or more of Examples 1-4 optionally includes the feature that the first wavelength comprises 358 nanometers to 405 nanometers.

[0255] In Example 6, the subject matter of any one or more of Examples 1-5 optionally includes a feature where the scope further includes a second light emitter configured to project light of a second wavelength from the elongated body.

[0256] In Example 7, the subject matter of Example 6 optionally includes the feature that the second light emitter includes a light emitting diode. In Example 8, the subject matter of any one or more of Examples 6-7 optionally includes the feature that the second wavelength comprises 400 nanometers to 700 nanometers.

[0257] In Example 9, the subject matter of any one or more of Examples 1-8 optionally includes the feature that an optically transparent fiber extends through the elongate body to the first light emitter.

[0258] In Example 10, the subject matter of Example 9 optionally includes the feature that optically transparent fibers are embedded within the material of the elongate body.

[0259] In Example 11, the subject matter of any one or more of Examples 9-10 optionally includes the feature that the optically transparent fiber extends at least partially through a lumen in the elongate body.

[0260] In Example 12, the subject matter of any one or more of Examples 1-11 optionally includes a light source connected to the first light emitter.

[0261] In Example 13, the subject matter of Example 12 optionally includes the feature that the light source is carried by the scope.

[0262] In Example 14, the subject matter of any one or more of Examples 1-13 optionally includes the feature where the tissue collection device includes forceps.

[0263] In Example 15, the subject matter of Example 14 optionally includes the feature that the forceps includes: a first jaw pivotally connected to the elongated body; and a plurality of tines extending from the first jaw.

[0264] In Example 16, the subject matter of Example 15 optionally includes the feature that the plurality of teeth are fabricated from a fluorescent material.

[0265] In Example 17, the subject matter of any one or more of Examples 15-16 optionally includes the feature that the plurality of teeth are fabricated from a reflective material.

[0266] In Example 18, the subject matter of any one or more of Examples 1-17 optionally includes the feature that the tissue collection device includes an internal volume for storing the separated tissue.

[0267] In Example 19, the subject matter of any one or more of Examples 1-18 optionally includes the feature that the tissue collection device is fabricated from clear polycarbonate or glass.

[0268] In Example 20, the subject matter of any one or more of Examples 1-19 optionally includes the feature that the tissue collection device is optically enhanced to interact with the field of view of the imaging component, the optical enhancement including reflective properties, translucent properties, transparent properties, or magnifying properties.

[0269] Example 21 is a method for collecting biological material using a tissue collection device, the method including the steps of inserting the tissue collection device into an anatomical structure of a patient; guiding a tissue collector of the tissue collection device to a target tissue; illuminating the target tissue with excitation light; viewing the illuminated target tissue through the tissue collector; and collecting biological material from the target tissue with the tissue collector.

[0270] In Example 22, the subject matter of Example 21 optionally includes viewing the illuminated target tissue through a tissue collector.

[0271] In Example 23, the subject matter of Example 22 optionally includes viewing the target tissue through the tissue collector by viewing an image of the target tissue with a camera beyond the tissue collector.

[0272] In Example 24, the subject matter of Example 23 optionally includes the feature where viewing the image of the target tissue with the camera beyond the tissue collector includes viewing light emitted from the target tissue.

[0273] In Example 25, the subject matter of any one or more of Examples 21-24 optionally includes penetrating a surface of the target tissue with a tissue collector and viewing the newly exposed tissue within the penetrated surface.

[0274] In Example 26, the subject matter of any one or more of Examples 21-25 optionally includes irradiating the target tissue with excitation light by irradiating the target tissue with a laser.

[0275] In Example 27, the subject matter of any one or more of Examples 21-26 optionally includes illuminating the target tissue with excitation light to cause the target tissue to emit light.

[0276] In Example 28, the subject matter of any one or more of Examples 21-27 optionally includes the feature of illuminating the target tissue with excitation light by fluorescing the target tissue, and viewing the fluorescing target tissue includes viewing the fluoresced target tissue.

[0277] In Example 29, the subject matter of any one or more of Examples 21-28 optionally includes injecting a fluorescent material into the target tissue to create a luminescent target tissue.

[0278] In Example 30, the subject matter of any one or more of Examples 21-29 optionally includes illuminating the tissue collection device with a second light emitter.

[0279] In Example 31, the subject matter of Example 30 optionally includes the feature that the second light emitter emits visible light.

[0280] In Example 32, the subject matter of Example 31 optionally includes the feature that the excitation light has a wavelength in the range of 358 nanometers to 405 nanometers and the visible light has a wavelength in the range of 400 nanometers to 700 nanometers.

[0281] In Example 33, the subject matter of any one or more of Examples 21-32 optionally includes fluorescing the cutting edge of the tissue collector.

[0282] In Example 34, the subject matter of any one or more of Examples 21-33 optionally includes reflecting light by a cutting edge of the tissue collector.

[0283] In Example 35, the subject matter of any one or more of Examples 21-34 optionally includes viewing the target tissue through the tissue collector by viewing the target tissue through a translucent material of the tissue collector.

[0284] In Example 36, the subject matter of any one or more of Examples 21-35 optionally includes inserting an endoscope including a first longitudinal passage into a patient's anatomical structure; inserting an auxiliary scope including a second longitudinal passage into the first longitudinal passage; and inserting a tissue retrieval device into the second longitudinal passage to reach the target tissue.

[0285] In Example 37, the subject matter of any one or more of Examples 21-36 optionally includes collecting biological material from the target tissue with a tissue collector by operating forceps to sever a portion of the target tissue.

[0286] Each of these non-limiting examples can stand alone or can be combined with one or more of the other examples in various permutations or combinations.

[0287] The above detailed description includes references to the accompanying drawings, which form a part of the detailed description. The drawings show, by way of illustration, specific embodiments in which the invention may be practiced. These embodiments are also referred to herein as "examples." Such examples may include elements in addition to those shown or described. However, the inventors also contemplate examples in which only those elements shown or described are provided. Moreover, the inventors also contemplate examples using any combination or permutation of those elements (or one or more aspects thereof) shown or described with respect to a particular example (or one or more aspects thereof), or with respect to other examples (or one or more aspects thereof) shown or described herein.

[0288] In the event of a conflict in usage between this document and any document incorporated by reference, the usage in this document shall control.

[0289] In this document, the terms "a" or "an" are used, as is common in patent documents, to include one or more, regardless of any other instance or usage of "at least one" or "one or more." In this document, the term "or" is used to refer to a non-exclusive "or," such that "A or B" includes "A but not B," "B but not A," and "A and B," unless otherwise indicated. In this document, the terms "including" and "in which" are used as the plain-English equivalents of the terms "comprising" and "wherein," respectively. Also, in the following claims, the terms "including" and "comprising" are open-ended, i.e., systems, devices, articles, compositions, formulations, or processes that include elements in addition to those recited after such terms in a claim are still deemed to be within the scope of that claim. Moreover, in the following claims, terms such as "first," "second," and "third" are used merely as labels and are not intended to impose numerical requirements on their objects.

[0290] Examples of the methods described herein may be at least partially machine- or computer-implemented. Some examples may include computer-readable or machine-readable media encoded with instructions operable to configure an electronic device to perform a method such as that described in the examples. Implementations of such methods may include code (e.g., microcode, assembly language code, or higher-level language code, etc.). Such code may include computer-readable instructions for performing various methods. The code may form part of a computer program product. Further, in examples, the code may be tangibly stored on one or more volatile, non-transitory, or non-volatile tangible computer-readable media, such as during execution or at other times. Examples of these tangible computer-readable media may include, but are not limited to, hard disks, removable magnetic disks, removable optical disks (e.g., compact disks and digital video disks), magnetic cassettes, memory cards or sticks, random access memory (RAM), and read-only memory (ROM).

[0291] The above description is intended to be illustrative, not limiting. For example, the above-described examples (or one or more aspects thereof) could be used in combination with each other. Other embodiments could be utilized, for example, by one of ordinary skill in the art upon review of the above description. The Abstract is provided to comply with 37 CFR §1.72(b) to enable the reader to quickly ascertain the nature of the technical disclosure. It is submitted with the understanding that it will not be used to interpret or limit the scope or meaning of the claims. Also, in the above Detailed Description, various features may be grouped together to streamline the disclosure. This should not be construed as intending that an unclaimed disclosed feature is essential to any claim. Rather, inventive subject matter may lie in fewer than all features of a particular disclosed embodiment. Thus, it is contemplated that the following claims are incorporated into the Detailed Description as examples or embodiments, with each claim standing on its own as a separate embodiment, and that such embodiments can be combined with each other in various combinations or permutations. The scope of the invention should be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled. [Explanation of symbols]

[0292] 10 Endoscopy System 12 Imaging and Control Systems 14 Endoscopy 16 Control Unit 18 Display unit, output unit 20 input units 22 Light source 24 Fluid supply source 26 Suction pump 28 Insert Section 30 Function Section 32 Handle Section 34 Cable Section 36 Coupler Section 38 Control Knob 40 ports 41 Cart 42 Image Processing Unit 44 Therapy Generator 46 Drive Unit 50 Side-viewing endoscope camera module 51 Angled Lamp Surface 52 Housing 53 spaces 54 Elevator 55 Deflector 55' Second position of deflector 55 56 Fluid outlet 57 Wire 58 Lighting Lens 59 tubes 60 objective lenses 61 pins 62 central lumens 63 Equipment 64 Optical transmitter 65 windows 66 Prism 67 Imaging Unit 68 Wiring 69 Fluid lines, grooves 100 Endoscope 102 Functional Modules 104 Insert Section Module 106 Control Module 108 Controller 110 Imaging Unit 112 Lighting Unit 114 Power Unit 120 Conduit wall 122 Sphincter of Oddi 124 Common bile duct 126 Main pancreatic duct 128 Entrance Aisle 129 130 Elevator section 132 lumens 134 Auxiliary Scope 136 lumens 137 Camera Lens 200 Surgical instruments 202 Long and slender body 204 Tissue collection device 206 Device Controller 210 Separator 212 Joe 212A Joe 212B Joe 213 teeth 214 Hinge 216 Activation Mechanism 218 Handle, Handpiece 220 Connector 222 Shaft 224 lumens 226 Cable 230 Endoscope 232 Shaft 234 Working Channel 236 Passage 238 Lens 239 Lens 240 field of view 254 Target Organizations 255 Anatomical Conduits 256 spaces 258 Sample Organizations 260 Laceration 300 Tissue Collection Device 302 Boring Device 304 Endoscope 310 Shaft 312 Container 314 Bowling Land 316 Blade 318 Bore 320 shaft 322 working channel 324 Passage 326 Lens 328 Field of View 329 Optical Lens 330 Target Organizations 342 Laceration 344 Line of Sight 400 Endoscopy System 402 Endoscope 404 Biopsy Instruments 408A Joe 408B Joe 410 Hinge 412 base 414A Control Cable 414B Control Cable 416A Coupler 416B Coupler 418 Handpiece 419 Cable 420A Coupler 420B Coupler 421 Connector 422 Shaft 424 lumens 426 Handpiece 428 Control 430 Connector 432 Cable 434 Distal end 436 Proximal end 438 Forceps 440 base 442A Joe 442B Joe 444 Hinge 446A Actuator 446B Actuator 448A Control Wire 448B Control Wire 450 Biopsy Instruments 452 Forceps 454 Sponge 456 Needle Array 458A Joe 458B Joe 460 Hinge 462 base 464 teeth 464 base 466 needles 468 tissue samples 500 Biopsy Instruments 502 Forceps 504A Joe 504B Joe 506 Base 508 Hinge 510A Rail 510B rail 512 teeth 514 tissue samples 550 Biopsy Instruments 552 Forceps 554 Joe 556 Joe 558 Hinge 560 base 562 teeth 564 Deflectable Wall 566A tissue sample 566B tissue sample 770 Optical Transmitter 772 Light source 700 Surgical instruments 702 Tissue collection device 710 Tissue Separator 712A Joe 712B Joe 713 teeth 714 Hinge 722 Shaft 732 Shaft 734 Working Channel 737 Excitation Lens 738 Imaging Lens 739 Lighting Lens 740 Illumination 750 forceps 754 Target Organizations 755 Anatomical Conduit 756 Space 757 Dye materials 768 Wiring 774 aisle 775 Excitation Light 776 Optical Transmitter 778 aisle A1 Central longitudinal axis B Axial direction CL center line D. duodenum D1 Distance D2 distance D3 Distance H1 Height Y1 direction Y2 direction

Claims

1. 1. A surgical instrument, comprising: an elongated body portion, a proximal end portion; a distal end portion; an elongate body including a bendable shaft extending from the proximal end portion to the distal end portion; a tissue separator coupled to the distal end portion, the tissue separator configured to engage sample tissue for collection; Including, A surgical instrument, wherein the tissue separator is at least partially made from a material that allows light to pass through the tissue separator.

2. 10. An endoscopy system including the surgical instrument of claim 1, said endoscopy system further including an endoscope, said endoscope comprising: an elongated, bendable shaft having a first lumen, the elongated body being disposable within the first lumen; a viewing device configured to view the tissue separator extended from the first lumen by the elongate body; and Including, An endoscopy system, wherein the viewing device is positioned to view through the tissue separator.

3. The surgical instrument of claim 1 , wherein the tissue separator comprises a tissue removal device having reflective, translucent, transparent, or magnifying properties.

4. The surgical instrument of claim 1 , wherein the tissue separator is fabricated from clear polycarbonate or glass.

5. The surgical instrument of claim 1 , wherein the tissue separator includes an interior volume for storing separated tissue.

6. The surgical instrument of claim 1 , wherein the tissue separator comprises an auger or a punch.

7. The tissue separator includes a forceps, the forceps comprising: First Joe and; a plurality of teeth extending from the first jaw; a second jaw disposed opposite the first jaw; and Including, the first jaw being pivotable from a closed position engaged with the second jaw to an open position spaced apart from the second jaw; The surgical instrument of claim 1 , wherein an internal storage volume is defined between the first jaw and the second jaw.

8. The surgical instrument of claim 7 , wherein the plurality of tines are fabricated from a fluorescent or reflective material.

9. The surgical instrument of claim 7 , wherein the forceps includes a capacity-enhancing feature configured to enable the forceps to hold multiple tissue samples.

10. The surgical instrument of claim 9, wherein the volume-enhancing feature includes a tissue biasing device configured to immobilize a piece of tissue held between the first jaw and the second jaw in the open position.

11. the tissue biasing device a sponge positioned on the first jaw; a needle array positioned on the second jaw, the needle array positioned to penetrate the sponge when the first and second jaws are in the closed position; The surgical instrument of claim 10, comprising:

12. The surgical instrument of claim 9, wherein the volume-enhancing feature comprises a volume-increasing feature configured to increase an internal volume of at least one of the first and second jaws.

13. 13. The surgical instrument of claim 12, wherein the capacity-increasing feature includes a feature where at least one of the first jaw and the second jaw is configured to translate at a hinge in an opposite direction to the other of the first and second jaw to increase the internal storage volume between the first and second jaws.

14. 13. The surgical instrument of claim 12, wherein the capacity-increasing feature includes at least one of the first jaw and the second jaw configured with a flexible wall for increasing the internal storage volume between the first jaw and the second jaw.

15. 10. The surgical instrument of claim 1, further comprising a first light emitter coupled to the elongate body and configured to project light at a first wavelength distal to the distal end portion.

16. The surgical instrument of claim 15, wherein the first light emitter is configured to fluoresce a fluorophore.

17. The surgical instrument of claim 15, wherein the first light emitter comprises a laser and the first wavelength comprises 358 nanometers to 405 nanometers.

18. 16. The surgical instrument of claim 15, further comprising a second light emitter coupled to the elongate body and configured to project light distally of the distal end portion at a second wavelength different from the first wavelength.

19. The surgical instrument of claim 18, wherein the second light emitter comprises a light emitting diode and the second wavelength comprises 400 nanometers to 700 nanometers.

20. The surgical instrument of claim 15, further comprising an optically transparent fiber extending through the elongated body to the first light emitter.

21. 1. A method of collecting biological material using a tissue collection device, the method comprising: inserting the tissue retrieval device into the patient's anatomy; guiding a tissue collector of the tissue retrieval device to a target tissue; viewing the target tissue through the tissue collector; collecting biological material from the target tissue with the tissue collection device; A method comprising:

22. 22. The method of claim 21, wherein viewing the target tissue through the tissue collector comprises viewing an image of the target tissue with a video camera.

23. 22. The method of claim 21, wherein viewing the target tissue through the tissue collector comprises viewing the target tissue beyond or within the tissue collector.

24. 22. The method of claim 21, further comprising penetrating a surface of the target tissue with the tissue collector and viewing newly exposed tissue within the penetrated surface.

25. 22. The method of claim 21, wherein collecting biological material from the target tissue with the tissue retrieval device comprises operating forceps to sever a portion of the target tissue.

26. 22. The method of claim 21, wherein collecting biological material from the target tissue with the tissue retrieval device comprises boring a tissue punch into the target tissue or advancing an auger into the target tissue.

27. 22. The method of claim 21, further comprising illuminating the tissue collection device with a light emitter.

28. 28. The method of claim 27, further comprising reflecting light by a cutting edge of the tissue collection device or fluorescing a cutting edge of the tissue collection device.

29. 22. The method of claim 21, further comprising bending the tissue retrieval device to allow a cutting edge of the tissue retrieval device to engage tissue.

30. 22. The method of claim 21, further comprising storing tissue in the tissue collection device.

31. 31. The method of claim 30, wherein storing tissue in the tissue retrieval device comprises using a tissue biasing device to hold biological material in forceps.

32. 32. The method of claim 31, wherein retaining biological material within the forceps with the tissue biasing device further comprises perforating the collected tissue with tines.

33. 31. The method of claim 30, wherein storing tissue in the tissue retrieval device includes increasing the volume of a forceps with a volume-increasing feature.

34. 31. The method of claim 30, wherein increasing the capacity of the forceps with the capacity-increasing feature comprises sliding jaws of the forceps away from a pivot point to increase the distance from an opposing jaw, or bending walls of the jaws of the forceps to increase the internal volume of the jaws.

35. 22. The method of claim 21, wherein viewing the target tissue through the tissue collector comprises viewing the target tissue through a translucent material of the tissue collector.

36. The method comprises: inserting an endoscope including a first longitudinal passageway into the anatomy of the patient; inserting an auxiliary scope including a second longitudinal passageway into the first longitudinal passageway; inserting the tissue retrieval device into the second longitudinal passage to reach the target tissue; 22. The method of claim 21 further comprising:

37. The method comprises: illuminating the target tissue with excitation light to cause the target tissue to emit light; viewing the luminescent target tissue with a camera; 22. The method of claim 21 further comprising:

38. 38. The method of claim 37, wherein the method further comprises injecting a fluorescent material into the target tissue to create the luminescent target tissue, and wherein the excitation light causes the luminescent target tissue to fluoresce.

39. 38. The method of claim 37, wherein illuminating the target tissue with the excitation light comprises illuminating the target tissue with a laser.

40. The method further includes illuminating the tissue collection device with a second light emitter that emits visible light; the excitation light has a wavelength in the range of 358 nanometers to 405 nanometers; 38. The method of claim 37, wherein the visible light has a wavelength in the range of 400 nanometers to 700 nanometers.

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