Steering wheel with multi-channel manifold

Abstract

The invention provides a steering handle with a manifold that allows the operator to configure the endoscopic system in-situ for various tasks, including irrigation, aspiration, or both. [Solution] The endoscopic system of the disclosure facilitates the rapid readjustment of the laser fiber optic cable within the catheter assembly. For example, the laser fiber optic cable can be removed from the irrigation channel of the endoscopic system during laser lithotripsy and reinserted into the aspiration channel. In some embodiments, this removal and reinsertion can be performed in situ without removing the catheter from the patient or the organ being treated. These embodiments of the system of the disclosure reduce the time required to perform laser lithotripsy and further reduce trauma to the patient.

Description

Technical Field

[0001] Related Applications This application claims the benefit of U.S. Provisional Patent Application No. 62 / 794,328, filed Jan. 18, 2019, and U.S. Provisional Patent Application No. 62 / 868,271, filed Jun. 28, 2019. The disclosures of these provisional patent applications are hereby incorporated by reference in their entirety.

[0002] This disclosure generally relates to a steering handle for a flexible catheter, and more particularly to a steering handle for a laser lithotripsy ureteroscope having a multi-channel manifold.

Background Art

[0003] Kidney stones affect one in 500 Americans each year, causing severe pain and increasing healthcare costs. Surgical options for patients with symptomatic kidney stones include extracorporeal shock wave lithotripsy (ESWL), ureteroscopy, and percutaneous nephrolithotomy (PCNL). Each of the human kidney's anatomical structure, stone composition, and body type plays a significant role in the outcome and surgical approach decisions.

[0004] Over the past decade, the role of ureteroscopy has been improved by the reduction in the diameter of flexible catheter shafts, the improvement of steering and deflection performance, video imaging, the miniaturization of baskets and devices, and the evolution of lithotripsy (stone fragmentation) techniques due to the emergence of holmium (Ho):YAG lasers, thulium (Tm):YAG lasers, and thulium fiber lasers. Currently, more than 45% of kidney stone surgeries are performed using miniaturized ureteroscopy techniques and lasers.

[0005] Ureteroscopy involves the use of a small, flexible or rigid device called a ureteroscope to directly visualize and treat kidney stones. This ureteroscope device, which has a small "working" channel capable of capturing and displaying video images, is inserted into the bladder and ureter, ultimately confronting the stone. The stone can then be either destroyed with laser energy transmitted to the target site via an optical fiber, or extracted using a small basket inserted into the working channel.

[0006] The advantage of this type of surgery is that it eliminates the need for incisions because body orifices are used for access.

[0007] Ureteroscopy is often a good option for small stones in the ureter or kidney. The success rate of ureteroscopy in removing these types of stones is generally higher than that of shock wave lithotripsy. However, compared to shock wave lithotripsy, ureteroscopy is sometimes associated with a higher level of postoperative discomfort. [Overview of the project] [Problems that the invention aims to solve]

[0008] The discomfort associated with laser lithotripsy correlates with the amount of time the ureteroscope remains inside the patient's body. A laser endoscopic system that allows for shorter procedure times is therefore desirable. [Means for solving the problem]

[0009] Various embodiments of the present disclosure include a steering handle with a manifold that enables an operator to configure the endoscopic system in situ for various tasks, including irrigation, aspiration, or both. Furthermore, the endoscopic systems of the disclosure facilitate the rapid repositioning of the laser fiber within the catheter assembly. That is, for example, the laser fiber can be removed from the irrigation channel of the endoscopic system and reinserted into the aspiration channel during a laser lithotripsy procedure. In some embodiments, this removal and reinsertion can be performed in situ without removing the catheter from the patient or the organ being treated. In some embodiments, multiple working devices can be used simultaneously via multiple working channels. These embodiments of the systems of the present disclosure reduce the time required to perform laser lithotripsy procedures and further reduce trauma to the patient.

[0010] In some embodiments, the manifold may be configured to switch irrigation from a first working channel, i.e., the primary working channel, to a second working channel, i.e., the secondary working channel. Similarly, some embodiments allow switching suction from one working channel to the other. Furthermore, some embodiments allow both working channels to be configured to operate in either an "irrigation only" mode or an "suction only" mode. The ability to reconfigure the endoscopic surgical system in these ways allows the operator to perform flow and / or suction adjustments in the field. For example, if a working device is placed within a working channel used for irrigation, this working device may obstruct the working channel to areas where irrigation is insufficient. The ability to switch irrigation from an occupied working channel to an unoccupied working channel (or to irrigate using both working channels) allows the operator to "adjust" irrigation to suction by improving, for example, a temporarily inadequate conduit for irrigation. Similarly, if a working device is positioned within a working channel used for suction and obstructs the working channel to areas where suction is insufficient, some embodiments may allow suction to be regulated relative to irrigation by configuring the manifold in a "suction only" configuration. Maintaining balanced irrigation and suction flows over time increases the complete stone removal rate of endoscopic procedures (i.e., the probability that no residual stones are present in the patient at a specific point-in-time benchmark after the procedure).

[0011] The above-described embodiment can be realized in a compact manifold that can be housed within a catheter steering handle, and thus can be used literally in the palm of the operator's hand. Thus, the system of this disclosure provides a quick and easy remedy to be implemented in the event that a situation unfolds. This can be done spontaneously by the operator and does not require the time-consuming reconfiguration of the irrigation and / or aspiration source connections, while the catheter remains in place.

[0012] Structurally, various embodiments of the present disclosure illustrate and describe an endoscopic surgical system, which comprises a catheter shaft defining a central axis, the central axis extending from the proximal end portion through the distal end portion of the catheter shaft, and the catheter shaft having a main working channel and a secondary working channel extending parallel to the central axis; and a steering handle comprising a manifold, the manifold having a main working channel output port in fluid communication with the main working channel and a secondary working channel output port in fluid communication with the secondary working channel, and the manifold being configured to receive optical fibers for selective routing through the main working channel via the main working channel output port and through the secondary working channel via the secondary working channel output port. In some embodiments, the manifold has a main working channel input port for passing optical fibers to the main working channel via the main working channel output port. The manifold may also have a second optical fiber input port for passing optical fibers to the secondary working channel via the secondary working channel output port. In some embodiments, the catheter shaft is flexible. The laser fiber may be pre-installed at the factory. In some embodiments, one of the primary and secondary working channels permanently houses the laser fiber. The fiber may be routed through a manifold into one of the primary and secondary working channels. In some embodiments, a laser system is operably coupled to the fiber. The laser system may be an ablation laser system and may comprise one of a holmium:YAG laser, a thulium fiber laser, a thulium:YLF laser, and a thulium:YAG laser.

[0013] In some embodiments, the manifold includes an irrigation force port and a suction input port, and the manifold is configured to selectively isolate the secondary working channel from the irrigation force port and the suction input port. The manifold may also be configured to selectively isolate the primary working channel from the irrigation force port. Furthermore, the endoscopic surgical instrument may include an irrigation source in fluid communication with the irrigation force port and a suction source in fluid communication with the suction input port.

[0014] In various embodiments of this disclosure, an endoscopic surgical instrument is disclosed, comprising a steering handle comprising a housing for a manifold, the manifold comprising an irrigation force port, a secondary work channel input port, a primary work channel input port, a primary work channel output port, and a secondary work channel output port, and the manifold comprising one or more valves for selectively blocking the irrigation force port from the primary work channel output port and the secondary work channel output port. In some embodiments, the manifold comprises a plurality of valves for selectively establishing fluid communication between the irrigation force port and the primary work channel output port, and between the irrigation force port and the secondary work channel output port. In some embodiments, the plurality of valves can be configured to selectively establish fluid communication between the primary work channel input port and the primary work channel output port, and between the secondary work channel input port and the secondary work channel output port. In some embodiments, the irrigation force port is selectively blocked from the primary work channel output port by a first of the plurality of valves, and the irrigation force port is selectively blocked from the secondary work channel output port by a second of the plurality of valves.

[0015] In some embodiments, the main working channel circuit comprises a main working channel input port and a main working channel output port, and the main working channel circuit is configured to allow an optical fiber to pass through it. The main working channel circuit may include a third of a plurality of valves to selectively block the main working channel input port from the main working channel output port. In some embodiments, the main working channel circuit includes a compression fitting near the main working channel input port. In some embodiments, the secondary working channel circuit comprises a secondary working channel input port and a secondary working channel output port, and the secondary working channel circuit is configured to allow a working device to pass through it. The secondary working channel circuit may be configured to allow any one of the following to pass as a working device: an optical fiber, a basket, a guidewire, and a biopsy forceps. In some embodiments, the secondary working channel circuit includes a third of a plurality of valves to selectively block the secondary working channel input port from the secondary working channel output port. The secondary working channel circuit may include a compression fitting near the secondary working channel input port, for example, a TUOHY BORST adapter. In some embodiments, the manifold includes a suction input port, and the secondary work channel input port and the suction input port are selectively isolated from the secondary work channel output port by a third of a plurality of valves.

[0016] In some embodiments, the first, second, and third of the multiple valves are multiple-position valves coupled to a multiple-position selector switch and selectively positioned by the selector switch. The multiple-position selector switch may include a stem which rotates about a stem axis and connects the multiple-position valves to the selector switch, with each of the multiple-position valves being rotatable about the stem axis. In some embodiments, the multiple-position selector switch is a three-position selector switch, and the multiple-position valves are three-position valves.

[0017] The manifold may include a secondary working channel output port and a suction input port that is in fluid communication, with a fourth of several valves selectively blocking the suction input port from the secondary working channel output port. In some embodiments, each of the several valves includes a stem and a manual actuator extending through the housing.

[0018] In some embodiments of the present disclosure, the flexible catheter shaft comprises a proximal end portion and a distal end portion, defining a central axis extending from the proximal end portion to the distal end portion. The flexible catheter shaft defines a primary working channel and a secondary working channel extending parallel to the central axis, with the secondary working channel output port of the manifold being in fluid communication with the secondary working channel and the primary working channel output port of the manifold being in fluid communication with the primary working channel. The primary working channel may extend through the distal surface of the distal end portion of the flexible catheter shaft.

[0019] Various embodiments of this disclosure provide a method for repositioning a laser fiber located at the distal end of a catheter. The method includes the steps of providing a steering handle operably coupled to a flexible catheter and providing instructions to be used on a tangible, non-transient medium. These instructions include a removal step of removing the laser fiber from a first fluid circuit of the steering handle and the flexible catheter, the first fluid circuit extending through the distal end of the flexible catheter, and an insertion step of inserting the laser fiber into a second fluid circuit of the steering handle and the flexible catheter, the second fluid circuit extending through the distal end of the flexible catheter. The first fluid circuit is separate and distinct from the second fluid circuit. In some embodiments, these instructions include, before the removal step, the step of removing the laser fiber from a first compression joint of the first fluid circuit, and after the insertion step, the step of sealing the fiber laser in a second compression joint of the second fluid circuit. These instructions may also include a step of positioning the distal end of the flexible catheter within the body organ before the removal and insertion steps, and a step of leaving the distal end of the flexible catheter in place within the body organ between the removal and insertion steps. In some embodiments, after the positioning step, and before the removal and insertion steps, a step of shutting off one or both of the first and second fluid circuits from the irrigation source. These instructions may also include a step of shutting off one or both of the first and second fluid circuits from the suction source after the positioning step, and before the removal and insertion steps. The body organ may be one of the bladder, ureter, and kidney.

[0020] In various embodiments of the present disclosure, a method for changing the direction of flow through at least one lumen of a catheter includes the steps of providing a steering handle to which a manifold is attached, the manifold being operably coupled to the catheter, and providing commands to be used on a tangible, non-transient medium. These commands include the steps of closing a first valve of the manifold to isolate the first lumen of the catheter from one of a suction source and an irrigation source, wherein the first valve is accessible on the steering handle, and opening a second valve of the manifold to fluidize the first lumen of the catheter to the other of the suction source and irrigation source, wherein the second valve is accessible on the steering handle. In some embodiments, the step of opening the second valve isolates the irrigation source from the second lumen of the catheter. In some embodiments, the first and second valves are actuated using a single changeover switch accessible on the steering handle.

[0021] These instructions may further include a step of removing a work device from a first lumen via a work device input port on a manifold, the work device input port being in fluid communication with the first lumen and accessible on the steering handle. After the step of removing the work device from the first lumen, these instructions may include a step of sealing the work device input port. In some embodiments, these instructions include a step of shutting off the work device input port from the first lumen using a third valve on the manifold, the third valve being accessible on the steering handle.

[0022] In some embodiments, these instructions include a step of fluidizing the first lumen and the work device input port of the manifold using a third valve of the manifold, the third valve being accessible on the steering handle. These instructions may also include a step of inserting a work device into the first lumen using the work device input port, the work device input port being in fluid communication with the first lumen and being accessible on the steering handle. In some embodiments, after the step of inserting the work device into the first lumen, these instructions include a step of sealing the work device input port around the work device. These instructions may also include a step of connecting a suction source to the work channel input port of the manifold on the steering handle, the work channel input port being in fluid communication with the first channel.

[0023] In various embodiments of the present disclosure, a method for selectively increasing the irrigation flow through a catheter includes the steps of: providing a steering handle to which a manifold is attached, wherein the manifold is operably coupled to the catheter; and providing instructions to be used on a tangible, non-transient medium. These instructions include the steps of: coupling an irrigation source to an irrigation port of the manifold, wherein the irrigation port is accessible on the steering handle; establishing an irrigation flow from the irrigation source through the irrigation port to a first lumen of the catheter; and opening a valve of the manifold to establish fluid communication between a second lumen of the catheter and the irrigation port, wherein the second valve is accessible on the steering handle. [Brief explanation of the drawing]

[0024] [Figure 1] This is a schematic diagram of an endoscope system according to one embodiment of the present disclosure. [Figure 2] This is a schematic diagram of a first manifold having a "W" shape that is operably coupled to an external system and catheter according to one embodiment of the present disclosure. [Figure 3] Schematic diagram of a second manifold operably coupled to an external system and a catheter according to an embodiment of the present disclosure. [Figure 4] Schematic diagram of a third manifold operably coupled to an external system and a catheter according to an embodiment of the present disclosure. [Figure 5] Schematic diagram of a configuration of a three-position valve adjustment of the third manifold of FIG. 4 according to an embodiment of the present disclosure. [Figure 6] Schematic diagram of a configuration of a three-position valve adjustment of the third manifold of FIG. 4 according to an embodiment of the present disclosure. [Figure 7] Schematic diagram of a fourth manifold operably coupled to an external system and a catheter according to an embodiment of the present disclosure. [Figure 8] Schematic diagram of a fifth manifold operably coupled to an external system and a catheter according to an embodiment of the present disclosure. [Figure 9A] Flowchart of a method for changing the position of a working device within a catheter of an endoscope system according to an embodiment of the present disclosure. [Figure 9B] Flowchart of a method for reversing the flow within a catheter of an endoscope system according to an embodiment of the present disclosure. [Figure 9C] Flowchart of a method for selectively increasing an irrigation flow passing through a catheter of an endoscope system according to an embodiment of the present disclosure. [Figure 10] Perspective view of a first steering handle including the first manifold of the schematic diagram of FIG. 2 according to an embodiment of the present disclosure. [Figure 11] Perspective view of a second steering handle including the second manifold of the schematic diagram of FIG. 3 according to an embodiment of the present disclosure. [Figure 12] Perspective view of a third steering handle including the third manifold of the schematic diagram of FIG. 4 according to an embodiment of the present disclosure. [Figure 13] Perspective view of a fourth steering handle including the fourth manifold of the schematic diagram of FIG. 7 according to an embodiment of the present disclosure. [Figure 14] This is a perspective view of a fifth steering handle comprising a fifth manifold as shown in the schematic diagram of Figure 8, according to one embodiment of the present disclosure. [Figure 15] Figure 10 is a partial side view of the housing in an open configuration of the operating valve according to one embodiment of the present disclosure. [Figure 15A] This is a perspective view of a single two-position valve actuator having a lever actuator according to one embodiment of the present disclosure. [Figure 15B] This is a cross-sectional view of the two-position valve actuator shown in Figure 15A, which is in a first rotational orientation within a housing according to one embodiment of the present disclosure. [Figure 15C] This is a cross-sectional view of the two-position valve actuator shown in Figure 15A, which is in a second rotational orientation within a housing according to one embodiment of the present disclosure. [Figure 16] Figure 10 is a partial side view of the housing in a closed configuration of the operating valve according to one embodiment of the present disclosure. [Figure 17] This is a partial side view of the housing of Figure 10 in a state in which an alternative operating valve according to one embodiment of the present disclosure is in an open configuration. [Figure 18] This is a partial side view of the housing of Figure 10 in a closed configuration with an alternative operating valve according to one embodiment of the present disclosure. [Figure 19] This is a perspective view of a changeover switch actuator according to one embodiment of the present disclosure. [Figure 19A] This is a partial perspective view of the changeover switch in Figure 19 within an assembly in a manifold according to one embodiment of the present disclosure. [Figure 20A] This is a partial elevation view of the steering wheel of Figure 13, with the changeover switch according to one embodiment of the present disclosure in the first position. [Figure 20B] This is a partial view of the changeover switch of Figure 20A in a first position with the housing removed, according to one embodiment of the present disclosure. [Figure 20C] This is a schematic cross-sectional view of a three-position valve at the first position in Figure 20A, according to one embodiment of the present disclosure. [Figure 21A]This is a partial elevation view of the steering wheel of Figure 13, with the changeover switch according to one embodiment of the present disclosure in the second position. [Figure 21B] This is a partial view of the changeover switch of Figure 21A in a second position with the housing removed, according to one embodiment of the present disclosure. [Figure 21C] This is a schematic cross-sectional view of the three-position valve in Figure 21A, located in the second position in Figure 20A, according to one embodiment of the present disclosure. [Figure 22A] This is a partial elevation view of the steering wheel of Figure 13, with the changeover switch according to one embodiment of the present disclosure in the third position. [Figure 22B] This is a partial view of the changeover switch of Figure 22A in a second position with the housing removed, according to one embodiment of the present disclosure. [Figure 22C] This is a schematic cross-sectional view of the three-position valve in Figure 22A, located in the third position in Figure 21A, according to one embodiment of the present disclosure. [Figure 23] This figure shows a solid model of the conduit of the first manifold in the schematic diagram of Figure 2 according to one embodiment of the present disclosure. [Figure 24] Figure 23 shows an enlarged view of the first steering handle in Figure 10, with the housed conduit in one embodiment of the present disclosure shown by dashed lines. [Figure 25] This is an elevation view of a manifold embodying the schematic diagram in Figure 2 according to one embodiment of the present disclosure. [Figure 26] Figure 25 is a partial perspective view of a manifold attached to a housing according to one embodiment of the present disclosure. [Figure 27] This figure shows a solid model of the conduit of the manifold in the schematic diagram of Figure 3 according to one embodiment of the present disclosure. [Figure 28] Figure 27, according to one embodiment of the present disclosure, is an enlarged view of the steering handle in Figure 11, with the housed conduit shown by dashed lines. [Figure 29] This is a perspective view of a manifold embodying the schematic diagram in Figure 3 according to one embodiment of the present disclosure. [Figure 30]This is a cross-sectional view of a manifold embodying a schematic diagram of Figure 7 according to one embodiment of the present disclosure. [Figure 30A] Figure 30 is an enlarged cross-sectional view of the manifold. [Figure 31] Figure 30, according to one embodiment of the present disclosure, is an enlarged view of the steering handle in Figure 13, with the housed conduit shown by dashed lines. [Figure 32] This is a perspective view of a manifold embodying a schematic diagram of Figure 7 according to one embodiment of the present disclosure. [Figure 33] This is a perspective view of a manifold embodying a schematic diagram of Figure 8, which has a push / pull actuator according to one embodiment of the present disclosure. [Figure 34] Figure 33 is an end view of the manifold in which a push / pull actuator according to one embodiment of the present disclosure is configured with only a first irrigation setting. [Figure 34A] This is a cross-sectional view of surface AA in Figure 34 according to one embodiment of the present disclosure. [Figure 35] Figure 33 is an end view of the manifold in which a push / pull actuator according to one embodiment of the present disclosure is configured with only a second irrigation setting. [Figure 35A] This is a cross-sectional view of surface AA in Figure 35 according to one embodiment of the present disclosure. [Figure 36] Figure 33 is an end view of the manifold in which a push / pull actuator according to one embodiment of the present disclosure is configured for suction only. [Figure 36A] This is a cross-sectional view of surface AA in Figure 36 according to one embodiment of the present disclosure. [Figure 37] Figure 33 is an end view of the manifold in which a push / pull actuator according to one embodiment of the present disclosure is configured in a suction + irrigation configuration. [Figure 37A] This is a cross-sectional view of surface AA in Figure 37 according to one embodiment of the present disclosure. [Figure 38] Figure 33 is an end view of the manifold in which a push / pull actuator according to one embodiment of the present disclosure is configured with only a first irrigation setting. [Figure 38A] This is a cross-sectional view of surface AA in Figure 38 according to one embodiment of the present disclosure. [Modes for carrying out the invention]

[0025] Referring to Figure 1, a schematic diagram of an endoscopic system 40 for laser lithotripsy according to one embodiment of the present disclosure is shown. This endoscopic system 40 comprises a catheter 44 and a steering handle 42 coupled to various external systems 46. The steering handle 42 comprises a manifold 48 configured to be coupled to at least some of the external systems 46. In some embodiments, the manifold 48 receives various inputs from and / or outputs various outputs to an irrigation system 52, an inhalation or suction system 54, and a laser system 56 (e.g., an ablation laser system). The laser system may include, for example, a holmium:YAG laser source, a thulium fiber laser source, a thulium:YLF laser source, or a thulium:YAG laser source. Other external systems 46 may also take a path that passes through the steering handle 42, but not necessarily through the manifold 48 (e.g., the illustrated optical system 62 and imaging system 64). The catheter 44 comprises a catheter shaft 66, which has a central axis or catheter axis 68 extending from a proximal end portion 72 through a distal end portion 74. In some embodiments, the catheter 44 comprises a distal head portion 76 coupled to the distal end portion 74 of the catheter shaft 66. In some embodiments, the catheter 44 and catheter shaft 66 are flexible (see figure).

[0026] Referring to Figure 2, a schematic diagram 80 shows an irrigation system 52, a suction system 54, a laser system 56, and a manifold 48a operably coupled to the proximal end portion 72 of the catheter shaft 66 and the catheter 44 according to one embodiment of the present disclosure. In this specification, a manifold is indicated by reference numeral 48 as general or collective, and by reference numeral 48 followed by a letter subscript (e.g., “manifold 48a”) as individual or specific. The manifold 48a comprises a plurality of output ports 94 and a plurality of input ports 92 in fluid communication via a plurality of conduits 90. A plurality of shut-off valves 96 are operably coupled to the plurality of conduits 90 of the manifold 48a. In some embodiments, each of the plurality of shut-off valves 96 is coupled to each of the plurality of conduits 90. The shut-off valves 96 may be “two-position” valves or binary valves that are either “on” (e.g., allowing flow) or “off” (e.g., blocking or preventing flow). One or more of the input ports 92 may be equipped with a compression joint 98.

[0027] In some embodiments, a plurality of input ports 92 may comprise a main working channel input port 102, an irrigation force port 104, and a secondary working channel input port 106. A plurality of output ports 94 of the manifold 48a may comprise a main working channel output port 122 and a secondary working channel output port 124. The main working channel input port 102 may be operably coupled to an ablation laser system 56. The irrigation force port 104 may be coupled to an irrigation system 52. The secondary working channel input port 106 may be coupled to a suction system 54. In some embodiments, the secondary working channel input port 106 corresponds to a working device 148 instead of a suction system 54. In this specification, “working channel” may be configured to correspond to working tools such as laser fibers and baskets, or to correspond to an irrigation flow or a suction flow or both, or to correspond to any combination thereof.

[0028] Multiple fluid circuits 110 are determined by a specific combination of input ports 92, conduits 90, output ports 94, and catheter lumens 140, and the fluid circuits 110 are enabled by opening their respective shut-off valves 96. In the case of manifold 48a, the multiple circuits 110 include a main working channel circuit 112, a first irrigation circuit 114, a secondary working channel circuit 116, and a second irrigation circuit 118. The main working channel circuit 112 consists of a main working channel input port 102, a main working channel conduit 90a, a main working channel output port 122, and a main working channel 142, which are selectively connected via shut-off valves 96a. The first irrigation circuit 114 consists of an irrigation force port 104, a first irrigation conduit 90b, a main working channel output port 122, and a main working channel 142, which are selectively connected via shut-off valves 96b. The secondary work channel circuit 116 consists of a secondary work channel input port 106, a secondary work channel conduit 90d, a secondary work channel output port 124, and a secondary work channel 144, which are selectively connected via a shut-off valve 96d. The second irrigation circuit 118 consists of an irrigation force port 104, a second irrigation conduit 90c, a secondary work channel output port 124, and a secondary work channel 144, which are selectively connected via a shut-off valve 96c.

[0029] Multiple fluid circuits 110 and shut-off valves 96 can be operated to selectively establish fluid communication between multiple input ports 92 and multiple output ports 94. In some embodiments, the multiple shut-off valves 96 are configured to selectively establish fluid communication between the main work channel input port 102 and the main work channel output port 122, between the irrigation force port 104 and the main work channel output port 122, between the irrigation force port 104 and the secondary work channel output port 124, and between the secondary work channel input port 106 and the secondary work channel output port 124.

[0030] In some embodiments, the plurality of conduits 90 consists of four conduits 90a to 90d, and the plurality of shut-off valves 96 consists of four corresponding shut-off valves 96a to 96d. In these embodiments, the main work channel input port 102 is selectively shut off from the main work channel output port 122 by the first shut-off valve 96a of the plurality of shut-off valves 96, the irrigation force port 104 is selectively shut off from the main work channel output port 122 by the second shut-off valve 96b of the plurality of shut-off valves 96, the irrigation force port 104 is selectively shut off from the secondary work channel output port 124 by the third shut-off valve 96c of the plurality of shut-off valves 96, and the secondary work channel input port 106 is selectively shut off from the secondary work channel output port 124 by the fourth shut-off valve 96d of the plurality of shut-off valves 96. Alternatively, a single three-position valve (not shown) may be used instead of the two shut-off valves 96b and 96c, which will bring the irrigation port into fluid communication with either or both of the main work channel output port 122 and the secondary work channel output port 124.

[0031] The catheter 44 comprises a plurality of lumens 140, which penetrate the catheter 44 and extend at least along the length of the catheter shaft 66, and are parallel to the central axis 68. The plurality of lumens 140 each comprise a primary working channel 142 and a secondary working channel 144. In some embodiments, the catheter shaft 66 defines the primary working channel 142 and the secondary working channel 144. Each of the primary working channel 142 and the secondary working channel 144 penetrates the distal end portion 74 of the catheter shaft 66.

[0032] In some embodiments, the optical fiber input port 102 comprises a first compression joint 132 in a compression joint 98, the first compression joint 132 configured to receive a laser optical fiber 150 which is operably coupled to a laser source of an ablation laser system 56. The first compression joint 132 may be installed between the optical fiber input port 102 and a shut-off valve 96a (see drawing). Alternatively, the shut-off valve 96a may be installed between the optical fiber input port 102 and the first compression joint 132. In some embodiments, the first compression joint defines the optical fiber input port 102. One or more of the compression joints 98 may be a TUOHY BORST adapter configured for use with one or more work devices 148. In some embodiments, a secondary work channel input port 106 corresponds to an alternative configuration, and the secondary work channel input port 106 is coupled to either a suction system 54 or a second compression joint 134 in the compression joint 98. The second compression joint 134 may consist of one of various working devices 148, such as a basket, a guidewire, or a biopsy forceps (none of which are shown). The second compression joint may also be configured to receive an optical fiber 150 (see drawing) as the working device 148.

[0033] In some embodiments, the steering handle 42 and catheter 44 are pre-assembled or factory-installed with the laser optical fiber 150 in place. The factory-installed optical fiber 150 may be removable as disclosed herein or permanently installed, with one of the work channels 142, 144 dedicated to housing the laser optical fiber 150.

[0034] Functionally, the steering handle 42 incorporates various external components or systems 46 for control and delivery to the catheter 44. Multiple shut-off valves 96 enable the manifold 48a to be configured to selectively shut off the secondary working channel 144 from the irrigation force port 104 and / or the suction input port 106, and also enable the manifold 48a to be configured to selectively shut off the primary working channel 142 from the optical fiber input port 102 and / or the irrigation force port 104. Compression joints 98 enable the passage of the laser optical fiber 150 or other working device 148 while preventing the irrigation fluid and / or suction fluid from leaking around the working device 148 during operation. This flexibility in introducing a working device 148 other than the laser optical fiber 150 allows the endoscopic system 40 to be implemented for use other than ablation therapy. Embodiments having the option of providing compression joints 132 and 134 for both the optical fiber input port 102 and the secondary working channel input port 106 allow the laser optical fiber 150 to be selectively configured to access the target zone from either the primary working channel 142 or the secondary working channel 144 of the catheter 44.

[0035] During operation, the multiple shut-off valves 96 can be controlled to define multiple operating configurations, each exhibiting a unique combination of inputs and outputs. Examples of valve combinations relating to the manifold 48a are shown in Table 1 and described below.

[0036] In the first configuration of manifold 48a, shut-off valves 96a, 96b, and 96c are opened, shut-off valve 96d is closed, and the laser optical fiber 150 is inserted through shut-off valve 96a and the first compression joint 132. This first configuration is a "drenching only" configuration, allowing drenching through both the main working channel 142 and the secondary working channel 144, with the laser optical fiber 150 located in the main working channel 142.

[0037] [Table 1]

[0038] In the second configuration of manifold 48a, shut-off valves 96b, 96c, and 96d are opened, shut-off valve 96a is closed, and the optical fiber 150 is inserted through shut-off valve 96d. In this second configuration, the suction system 54 is uncoupled, and the second compression joint 134 can be coupled to the secondary working channel input port 106. The second configuration is also a "drenching only" configuration, allowing drenching through both the main working channel 142 and the secondary working channel 144, but the laser optical fiber 150 is located within the secondary working channel 144.

[0039] In the third configuration of manifold 48a, shut-off valves 96a, 96b, and 96d are opened, shut-off valve 96c is closed, and the laser optical fiber 150 is inserted through shut-off valve 96a and the first compression joint 132. This third configuration is an "irrigation / suction" configuration, allowing both irrigation and suction to be performed on the catheter 44, with the laser optical fiber 150 located within the main working channel 142.

[0040] In the fourth configuration of manifold 48a, shut-off valves 96a and 96d are opened and shut-off valves 96b and 96c are closed. This fourth configuration is a "suction only" configuration, and the laser optical fiber 150 is located within the main working channel 142.

[0041] In the fifth configuration of manifold 48a, shut-off valves 96b and 96c are closed, while the positions of shut-off valves 96a and 96d are variable and unspecified. This fifth configuration is a “transition” configuration, in which the catheter 44 and the output port 94 of the manifold are shut off from the irrigation system 52 and the aspiration system 54, while the optical fiber input port 102 and the secondary work channel input port 106 can be opened or closed. As described below in relation to Figure 7, the transition configuration may be implemented, for example, when switching the optical fiber 150 (or other work device 148) from the main work channel circuit 112 to the secondary work channel circuit 116, or when switching the optical fiber 150 (or other work device 148) from the secondary work channel circuit 116 to the main work channel circuit 112.

[0042] In the sixth configuration of manifold 48a, all shut-off valves 96a to 96d are closed and the laser optical fiber 150 is withdrawn. This sixth configuration is a "closed" configuration that completely isolates the catheter 44 from the irrigation system 52, the aspiration system 54, and the ablation laser system 56.

[0043] Referring to Figure 3, schematic diagram 180 shows a manifold 48b operably coupled to an irrigation system 52, a suction system 54, an ablation laser system 56, and the proximal end portion 72 of a catheter 44, according to one embodiment of the present disclosure. The manifold 48b has many of the same components and attributes as the manifold 48a in Figure 2, and these components and attributes are indicated by the same reference numerals.

[0044] Furthermore, manifold 48b includes a dedicated suction port 182 as one of a plurality of input ports 92. In some embodiments, both the secondary work channel input port 106 and the suction port 182 access the same conduit 90 (i.e., secondary work channel conduit 90d). Manifold 48b may also include a shut-off valve 96e as one of a plurality of shut-off valves 96. The shut-off valve 96d may be installed between the secondary work channel input port 106 and a second compression fitting 134 (see drawing). Alternatively, the second compression fitting 134 may be installed between the secondary work channel input port 106 and the shut-off valve 96d. In some embodiments, the second compression fitting 134 defines the secondary work channel input port 106.

[0045] In the case of manifold 48b, the multiple fluid circuits 110 include a suction circuit 184. The suction circuit 184 consists of a suction port 182, a secondary working channel conduit 90d, a secondary working channel output port 124, and a secondary working channel 144, which are selectively connected via a shut-off valve 96e.

[0046] Functionally, the dedicated suction port 182 allows the working device 148 to access the secondary working channel 144 without compromising suction. Thus, the secondary working channel 144 can accommodate the working device 148 (e.g., the laser optical fiber 150) and also function as a suction channel.

[0047] During operation, the multiple shut-off valves 96 can be controlled to define multiple operating configurations, each exhibiting a unique combination of inputs and outputs. Examples of valve combinations relating to manifold 48b are shown in Table 2 and described below.

[0048] In the first configuration of manifold 48b, shut-off valves 96a, 96b, and 96c are open, shut-off valves 96d and 96e are closed, and the laser optical fiber 150 is inserted through shut-off valve 96a and the first compression joint 132. This first configuration is a "drenching only" configuration, allowing drenching through both the main working channel 142 and the secondary working channel 144, with the laser optical fiber 150 located within the main working channel 142.

[0049] In the second configuration of manifold 48b, shut-off valves 96b, 96c, and 96d are opened, shut-off valves 96a and 96e are closed, and the optical fiber 150 is inserted through shut-off valves 96d and the second compression joint 134. This second configuration is also a "drenching only" configuration, allowing drenching through both the main working channel 142 and the secondary working channel 144, although the laser optical fiber 150 is located within the secondary working channel 144.

[0050] [Table 2]

[0051] In the third configuration of manifold 48b, shut-off valves 96a, 96b, and 96e are opened, shut-off valves 96c and 96d are closed, and the laser optical fiber 150 is inserted through shut-off valve 96a and the first compression joint 132. This third configuration is an "irrigation / suction" configuration, allowing both irrigation and suction to be performed on the catheter 44, with the laser optical fiber 150 located within the main working channel 142.

[0052] In the fourth configuration of manifold 48b, shut-off valves 96b, 96d, and 96e are opened, shut-off valves 96a and 96c are closed, and the laser optical fiber 150 is inserted through shut-off valves 96d and the second compression joint 134. This fourth configuration is also a “drain / suction” configuration, allowing both draining and suction to the catheter 44, but the laser optical fiber 150 is located within the secondary working channel 144.

[0053] In the fifth configuration of manifold 48b, shut-off valves 96a and 96e are opened, and shut-off valves 96b, 96c, and 96d are closed. This fifth configuration is a "suction only" configuration, and the laser optical fiber 150 is located within the main working channel 142.

[0054] In the sixth configuration of manifold 48b, shut-off valves 96d and 96e are opened, and shut-off valves 96a, 96b, and 96c are closed. This sixth configuration is a "suction only" configuration, and the laser optical fiber 150 is located within the secondary working channel 144.

[0055] In the seventh configuration of manifold 48b, shut-off valves 96b, 96c, and 96e are closed, while the positions of shut-off valves 96a and 96d are variable and unspecified. This seventh configuration is a “transition” configuration, in which the catheter 44 and the output port 94 of the manifold are shut off from the irrigation system 52 and the aspiration system 54, while the optical fiber input port 102 and the secondary work channel input port 106 can be opened or closed. As described below in relation to Figure 7, the transition configuration may be implemented, for example, when switching the optical fiber 150 (or other work device 148) from the main work channel circuit 112 to the secondary work channel circuit 116, or when switching the optical fiber 150 (or other work device 148) from the secondary work channel circuit 116 to the main work channel circuit 112.

[0056] In the eighth configuration of manifold 48b, all of the shut-off valves 96a to 96e are closed and the laser optical fiber 150 is withdrawn. This eighth configuration is a "closed" configuration that completely isolates the catheter 44 from the irrigation system 52, the aspiration system 54, and the ablation laser system 56.

[0057] Referring to Figures 4 to 6, schematic diagram 200 shows a manifold 48c operably coupled to an irrigation system 52, a suction system 54, an ablation laser system 56, and the proximal end portion 72 of a catheter 44, according to one embodiment of the present disclosure. The manifold 48c has many of the same components and attributes as the manifold 48b in Figure 3, and these components and attributes are indicated by the same reference numerals.

[0058] Manifold 48c includes a changeover switch 202 for operating some or all of the multiple shut-off valves 96. In the case of manifold 48c, the changeover switch 202 includes a link 204 which is coupled to the shut-off valves 96b, 96c, and 96e. The changeover switch 202 may be a three-position switch (see drawing), and each of the shut-off valves 96b, 96c, and 96e may be a three-position valve 206 which can be configured for three distinct flow / shut-off orientations (again, see drawing). These three positions of the changeover switch 202 are indicated as 1, 2, and 3 in the drawing. In each position, each three-position valve 206 either shuts off or enables its respective circuit 110.

[0059] Functionally, similar to manifold 48b, the dedicated suction port 182 of manifold 48c allows the work device 148 to access the secondary work channel 144 without compromising suction. The changeover switch 202 operates shut-off valves 96b, 96c, and 96e simultaneously, while shut-off valves 96a and 96d are operated individually. Each position of the changeover switch 202 corresponds to one of the respective positions of the three-position valve 206.

[0060] During operation, the changeover switch 202 and the shut-off valves 96a and 96d can be controlled to define multiple operating configurations, each exhibiting a unique combination of inputs and outputs. An example of valve combinations for manifold 48c is shown in Table 3 and described below.

[0061] In the first configuration of manifold 48c, the changeover switch 202 is set to position 1, which corresponds to the "drenching only" configuration 212, where shut-off valves 96b and 96c are configured in the open configuration and shut-off valve 96e is configured in the closed configuration. This drenching only configuration 212 is shown in Figure 4. Shut-off valve 96a is opened and shut-off valve 96d is closed, and the laser optical fiber 150 is inserted through shut-off valve 96a and the first compression joint 132. In this first configuration, drenching is made possible through both the main working channel 142 and the secondary working channel 144, with the laser optical fiber 150 located in the main working channel 142.

[0062] [Table 3]

[0063] In the second configuration of manifold 48c, the changeover switch is set to position 1, which is the same as the first configuration, for irrigation only. The shut-off valve 96d is opened, the shut-off valve 96a is closed, and the laser optical fiber 150 is inserted through the shut-off valve 96d and the second compression joint 134. In this second configuration, irrigation is made possible through both the main working channel 142 and the secondary working channel 144, with the laser optical fiber 150 located in the secondary working channel 144.

[0064] In the third configuration of manifold 48c, the changeover switch 202 corresponding to the "irrigation + aspiration" configuration 214 is set to position 3, where shut-off valves 96b and 96e are configured in the open configuration and shut-off valve 96d is configured in the closed configuration. The irrigation + aspiration configuration 214 is shown in Figure 6. Shut-off valve 96a is open and shut-off valve 96d is closed, and the laser optical fiber 150 is inserted through shut-off valve 96a and the first compression joint 132. In this third configuration, both irrigation and aspiration are possible with respect to the catheter 44, and the laser optical fiber 150 is located within the main working channel 142.

[0065] In the fourth configuration of manifold 48c, the changeover switch is set to position 3, which corresponds to the same irrigation + aspiration effect as in the third configuration. The shut-off valve 96d is opened, the shut-off valve 96a is closed, and the laser optical fiber 150 is inserted through the shut-off valve 96d and the second compression joint 134. In this fourth configuration, both irrigation and aspiration are possible with respect to the catheter 44, and the laser optical fiber 150 is located within the secondary working channel 144.

[0066] In the fifth configuration of manifold 48c, shut-off valves 96b, 96c, and 96e are closed, while the positions of shut-off valves 96a and 96d are variable and unspecified. This fifth configuration is a “transition” configuration, in which the catheter 44 and the output port 94 of the manifold are shut off from the irrigation system 52 and the aspiration system 54, while the optical fiber input port 102 and the secondary work channel input port 106 can be opened or closed. As described below in relation to Figure 7, the transition configuration may be implemented, for example, when switching the optical fiber 150 (or other work device 148) from the main work channel circuit 112 to the secondary work channel circuit 116, or when switching the optical fiber 150 (or other work device 148) from the secondary work channel circuit 116 to the main work channel circuit 112.

[0067] In the sixth configuration of manifold 48c, the changeover switch is set to position 2, closing the shut-off valves 96b, 96c, and 96e. The shut-off valves 96a and 96d are closed, and the laser optical fiber 150 is withdrawn. This sixth configuration is a "closed" configuration that completely isolates the catheter 44 from the irrigation system 52, the aspiration system 54, and the ablation laser system 56.

[0068] Referring to Figure 7, a schematic diagram 230 shows a manifold 48d operably coupled to an irrigation system 52, a suction system 54, an ablation laser system 56, and the proximal end portion 72 of a catheter 44, according to one embodiment of the present disclosure. The manifold 48d has many of the same components and attributes as the manifold 48c in Figures 4 to 6, and these components and attributes are indicated by the same reference numerals.

[0069] Unlike manifold 48c, manifold 48d does not have shut-off valves 96a and 96d. Instead of shutting off the optical fiber input port 102 and the secondary work channel input port 106, compression joints 132 and 134 are sealed either by the presence of a work device 148 (e.g., an optical fiber 150 as illustrated at the location of the optical fiber input port 102) or by using a cap or plug 232 (illustrated at the location of the secondary work channel input port 106).

[0070] During operation, the changeover switch 202 is operated as described in relation to Figures 4 to 6. The optical fiber input port 102 and the secondary work channel input port 106 are either occupied by the optical fiber 150 (or other work device 148) or selectively sealed with a cap or plug 232. An example of valve combinations for manifold 48d is shown in Table 4 and described below.

[0071] [Table 4]

[0072] In the first configuration of manifold 48d, the changeover switch 202 is set to position 1, which corresponds to the "irrigation only" configuration 212 (Figure 7). The first compression joint 132 is occupied and sealed by a working device 148 (e.g., the illustrated laser optical fiber 150). The second compression joint 134 is sealed with a cap or plug 232. In this first configuration, irrigation is made possible through both the main working channel 142 and the secondary working channel 144, with the working device 148 located in the main working channel 142.

[0073] In the second configuration of manifold 48d, the changeover switch is set to position 1 to have the same irrigation-only effect as in the first configuration. The second compression joint 134 is occupied and sealed by a working device 148 (e.g., a laser optical fiber 150). The first compression joint 132 is sealed with a cap or plug 232. In this second configuration, irrigation is made possible through both the main working channel 142 and the secondary working channel 144, with the working device 148 located in the secondary working channel 144.

[0074] In the third configuration of manifold 48d, the changeover switch 202 is set to position 3, which corresponds to the "irrigation + aspiration" configuration 214 (Figure 6). The first compression fitting 132 is occupied and sealed by the working device 148 (e.g., laser optical fiber 150). The second compression fitting 134 is sealed with a cap or plug 232. In this third configuration, both irrigation and aspiration are possible with respect to the catheter 44, and the laser optical fiber 150 is located within the main working channel 142.

[0075] In the fourth configuration of manifold 48d, the changeover switch 202 is set to position 3, which corresponds to the same irrigation + aspiration effect as in the third configuration. The second compression joint 134 is occupied and sealed by the working device 148 (e.g., laser optical fiber 150). The first compression joint 132 is sealed with a cap or plug 232. In this fourth configuration, both irrigation and aspiration are possible with respect to the catheter 44, and the laser optical fiber 150 is located within the secondary working channel 144.

[0076] In the fifth configuration of manifold 48d, shut-off valves 96b, 96c, and 96e are closed, while the positions of shut-off valves 96a and 96d are variable and unspecified. This fifth configuration is a “transition” configuration, in which the catheter 44 and the output port 94 of the manifold are shut off from the irrigation system 52 and the aspiration system 54, while the optical fiber input port 102 and the secondary work channel input port 106 can be opened or closed. As described below in relation to Figure 7, the transition configuration may be implemented, for example, when switching the optical fiber 150 (or other work device 148) from the main work channel circuit 112 to the secondary work channel circuit 116, or when switching the optical fiber 150 (or other work device 148) from the secondary work channel circuit 116 to the main work channel circuit 112.

[0077] In the sixth configuration of manifold 48d, the changeover switch 202 is set to position 2, closing the shut-off valves 96b, 96c, and 96e (Figure 5). The compression fittings 132 and 134 are sealed with caps or plugs 232, and the laser fiber optics 150 are withdrawn. This sixth configuration is a "closed" configuration that completely isolates the catheter 44 from the irrigation system 52, the aspiration system 54, and the ablation laser system 56.

[0078] Referring to Figure 8, schematic diagram 240 shows a manifold 48e operably coupled to an irrigation system 52, a suction system 54, an ablation laser system 56, and the proximal end portion 72 of a catheter 44 according to one embodiment of the present disclosure. The manifold 48e has many of the same components and attributes as the manifold 48d in Figure 7, and these components and attributes are indicated by the same reference numerals.

[0079] Similar to manifold 48d, manifold 48e does not have shut-off valves 96a and 96d and has an alternative configuration for circuit interruption as described in relation to Figure 7. Unlike manifold 48d, the remaining shut-off valves 96b, 96c, and 96e are not coupled to a single changeover switch. Instead, the shut-off valves 96b, 96c, and 96e are separate two-position valves similar to schematic diagram 180 in Figure 3.

[0080] During operation, each of the shut-off valves 96b, 96c, and 96e operates independently. The optical fiber input port 102 and the secondary work channel input port 106 are either occupied by the optical fiber 150 (or other work device 148) or selectively sealed with a cap or plug 232. An example of valve combinations for manifold 48e is shown in Table 5 and described below.

[0081] In the first configuration of manifold 48e, shut-off valve 96b is open, shut-off valve 96e is closed, and shut-off valve 96c may or may not be open. When shut-off valve 96c is closed, only the first irrigation circuit 114 is filled with irrigation fluid, and when shut-off valve 96c is open, irrigation circuits 114 and 118 may be filled with irrigation fluid. The first compression joint 132 is occupied and sealed by a working device 148 (e.g., the illustrated laser optical fiber 150). The second compression joint 134 is sealed with a cap or plug 232. In this first configuration, irrigation is made possible through both the main working channel 142 and the secondary working channel 144, with the working device 148 located in the main working channel 142.

[0082] [Table 5]

[0083] In the second configuration of manifold 48e, the shut-off valves 96b, 96c, and 96e are configured in the same way as in the first configuration, the second compression joint 134 is occupied and sealed by the working device 148 (e.g., laser optical fiber 150), and the first compression joint 132 is sealed by the plug or cap 232. This second configuration is also a "drenching only" configuration, allowing drenching through the main working channel 142 and / or the secondary working channel 144, but the laser optical fiber 150 is located within the secondary working channel 144.

[0084] In the third configuration of manifold 48e, shut-off valves 96b and 96c are closed and shut-off valve 96e is open. The working device 148 (e.g., laser optical fiber 150) is located within the first compression joint 132, and the second compression joint 134 is sealed with a cap or plug 232. This third configuration is a "suction only" configuration, in which only the suction circuit 184 is enabled and the working device 148 is located within the main working channel 142.

[0085] In the fourth configuration of manifold 48e, the shut-off valves 96b, 96c, and 96e are configured as in the second configuration, the second compression joint 134 is occupied and sealed by the working device 148 (e.g., laser optical fiber 150), and the first compression joint 132 is sealed by a plug or cap 232. This second configuration is also a "drenching only" configuration, allowing drenching via the main working channel 142 and / or the secondary working channel 144, but the laser optical fiber 150 is located within the secondary working channel 144.

[0086] In the fifth configuration of manifold 48e, shut-off valves 96b and 96e are opened and shut-off valve 96c is closed. The working device 148 (e.g., laser optical fiber 150) is located within the first compression fitting 132, and the second compression fitting 134 is sealed with a cap or plug 232. This fifth configuration is an "irrigation / aspiration" configuration in which both irrigation and aspiration are possible with respect to the catheter 44, and the working device 148 is located within the main working channel 142.

[0087] In the sixth configuration of manifold 48e, shut-off valves 96b and 96e are opened, shut-off valve 96c is closed, the second compression joint 134 is occupied and sealed by the working device 148 (e.g., laser optical fiber 150), and the first compression joint 132 is sealed with a plug or cap 232. This sixth configuration is also a "drain / suction" configuration, allowing both drainage and suction to be performed on the catheter 44, with the laser optical fiber 150 located within the secondary working channel 144.

[0088] In the seventh configuration of manifold 48e, the shut-off valves 96b, 96c, and 96e are closed, while the arrangement of compression joints 132 and 134 is variable and unspecified. This seventh configuration is a “transition” configuration in which the catheter 44 and the output port 94 of the manifold are isolated from the irrigation system 52 and the suction system 54, while one of the first compression joint 132 and the second compression joint 134 is occupied by a working device 148 (e.g., a laser optical fiber 150), and the other of the second compression joint 134 and the first compression joint 132 is occupied by a plug or cap 232. This transition configuration can be implemented, for example, when switching the working device 148 from the main working channel circuit 112 to the secondary working channel circuit 116, or from the secondary working channel circuit 116 to the main working channel circuit 112.

[0089] In the eighth configuration of manifold 48b, all of the shut-off valves 96a to 96e are closed and the laser optical fiber 150 is withdrawn. This eighth configuration is a "closed" configuration that completely isolates the catheter 44 from the irrigation system 52, the aspiration system 54, and the ablation laser system 56.

[0090] Referring to Figures 9A, 9B, and 9C, methods 250 for operating the endoscopic system 40 according to embodiments of the present disclosure are shown. Method 250a relates to repositioning a working device 148 (e.g., a laser optical fiber 150) located at the distal end portion 74 of the catheter 44. Method 250b relates to reversing the flow within the catheter 44. Method 250c relates to selectively increasing the irrigation flow through the catheter 44. Although these methods 250 are described in relation to the endoscopic system 40 of the present application, any catheter and a suitably equipped steering handle may be used in these methods 250.

[0091] Method 250 may be embodied in the form of a kit 252, in which a steering handle 42 and a catheter 44 are provided together with instructions 254 to be used on a tangible non-temporary medium 256 (Figure 1). Non-limiting examples of the tangible non-temporary medium 256 include paper documents (see drawing) or computer-readable media including compact disks and magnetic storage devices (e.g., hard disks, flash drives, cartridges, floppy drives). These computer-readable media may be locally connected or accessible via the Internet. The instructions 254 may be complete on a single medium or divided between two or more mediums. For example, kit 252 may include instructions 254 written on a paper document instructing an operator to access one or more steps of Method 250 via the Internet, with these Internet-accessible steps stored on the computer-readable medium. These instructions 254 may be in the form of written text, diagrams, and / or video displays. Method 250 may be performed without the assistance of Instruction 254 or without the provision of Kit 252. Therefore, steps 261, 271, and 281 of Method 250 are considered optional, because Method 250 may be performed on a steering handle and a pre-prepared catheter.

[0092] Referring to Figure 9A, Method 250a may include positioning the distal end portion 74 of the catheter 44 within a body organ (step 262) and leaving the distal end portion 74 in place within the body organ during the remaining steps of Method 250a. Examples of body organs into which this distal end portion 74 is inserted include the bladder, ureters, and kidneys. Step 262 is optional because Method 250a may be performed outside of a body organ.

[0093] Method 250a includes blocking one or both of the first fluid circuit and the second fluid circuit from one or both of the irrigation source and / or the suction source (step 263). With respect to the endoscope system 40, the first fluid circuit corresponds to either the first irrigation circuit 114 or the suction circuit 116. The second fluid circuit may be the other of the suction circuit 116 or the first irrigation circuit 114. It may also be the case that, with respect to the endoscopic system 40, the irrigation source corresponds to the irrigation system 52, and suction The source corresponds to the suction system 54. See Table 1 for an example configuration related to step 263. This includes the "Migration" configuration in Table 4. Step 263 is optional because Method 250 is a catheter and station not connected to the irrigation source and / or aspiration source. This is because it may be performed on the ring handle.

[0094] In some embodiments, method 250a includes removing the working device from the first compression joint of the first fluid circuit (step 264). With respect to the endoscope system 40, the working device corresponds to the working device 148 (e.g., laser optical fiber 150), and the first compression joint corresponds to the compression joint 98 (e.g., first compression joint 132 or second compression joint 134) in which the working device 148 is located at the start of method 250a. Step 264 is optional because method 250a may be performed on a system that does not have a compression joint.

[0095] The working device 148 is removed from the steering handle and the first fluid circuit of the catheter (step 265). With respect to the endoscopic system 40, the working device 148 is removed at the start of method 250a from either the main working channel circuit 112 or the suction circuit 116 in which the working device 148 is located.

[0096] The working device 148 is inserted into the steering handle and the second fluid circuit of the catheter (step 266). With respect to the endoscopic system 40, the working device 148 is inserted into either the main working channel circuit 112 or the suction circuit 116 in which the working device 148 is not located at the start of method 250a.

[0097] In some embodiments, method 250a includes sealing the working device 148 with a second compression joint of a second fluid circuit (step 267). With respect to the endoscope system 40, the second compression joint corresponds to a compression joint 134 or 132 of a secondary working channel circuit 116 or a primary working channel circuit 112 in which the working device 148 is not located at the start of method 250a. Step 267 is optional, because method 250a may be performed on a system that does not have a compression joint.

[0098] Functionally, method 250a allows the appropriately equipped steering handle and catheter working device to be modified at the distal end portion 74 of the catheter 44. This allows the operator to change the approach and impact angle of the ablation laser beam at the target. Such freedom can improve surgical outcomes. In the case of an endoscopic system with visual capabilities at the distal end portion 74 of the catheter 44, this also improves the operator's visibility of the working device and the laser beam impact at the target zone. In embodiments that allow the modification to be performed while the catheter 44 is inserted into the human body, this modification can be performed while reducing or avoiding the additional time and trauma associated with the removal and reinsertion of the catheter 44.

[0099] Referring to Figure 9B, a method 250b for reversing the flow in the catheter 44 is shown. This method 250b may include coupling the suction source 54 to the working channel input port 102 of the manifold 48 of the steering handle 42 (step 272). Some embodiments have a dedicated suction input channel 182 (e.g., manifold 48b), thus eliminating the need for this step. Therefore, step 272 is an optional step related to embodiments in which the suction source 54 and the working device 148 alternatively share the working channel input port 102 (e.g., manifold 48a).

[0100] In some embodiments, reversing the flow in the first lumen 140 of the catheter 44 involves the following two steps: closing the first of the multiple shut-off valves 96 of the manifold 48, thereby shutting off the lumen 140 from either the irrigation source 52 or the suction source 54 (step 273); and opening the second of the multiple shut-off valves 96 of the manifold 48, thereby creating fluid communication between the first lumen 140 and either the irrigation source 52 or the suction source 54 (step 274).

[0101] For example, referring to manifold 48a (Figure 2), in order to reverse the flow in the secondary working channel 144 from a suction flow to an irrigation flow, shut-off valve 96d is closed in step 273 and shut-off valve 96c is opened in step 274. In order to reverse the flow in the secondary working channel 144 from an irrigation flow to a suction flow, shut-off valve 96c is closed in step 273 and shut-off valve 96d is opened in step 274.

[0102] Functionally, the ability to reverse the flow within one of the catheter lumens allows for the correction of imbalances between the irrigation and suction flows. For example, if the suction flow rate exceeds the irrigation flow rate, the organ being treated may constrict, which can cause pain and injury. In this example, the ability to reverse the suction flow and introduce the irrigation flow allows for "adjusting" the irrigation mass relative to the suction mass (e.g., by configuring the endoscopic system 40 in "irrigation only" mode). Once the irrigation mass is sufficiently adjusted relative to the suction mass, the flow can be reversed again to avoid overfilling of the organ (e.g., by configuring the endoscopic system 40 in "irrigation + suction" or "suction only" mode). This degree of freedom allows the operator to continue working even during periods of flow imbalance caused by obstacles, such as the presence of a working device 148 or lithotripsy fragments placed in the suction channel. Reversing the flow can also serve to move obstructing lithotripsy fragments.

[0103] Referring to Figure 9C, a method 250c for increasing the irrigation flow within the catheter 44 is shown. Method 250c may include connecting the irrigation source 52 to the irrigation force port 104 of the manifold 48 of the steering handle 42 (step 282). In some embodiments, increasing the flow in the first lumen 140 of the catheter 44 involves the following two steps: a reference irrigation flow is established from the irrigation source 52 through the irrigation port 104 to the first lumen 140 of the catheter 44 (step 283); and one of the multiple shut-off valves 96 of the manifold 48 is opened to fluidize the second lumen 140 of the catheter 44 to the irrigation source 52 (step 284).

[0104] For example, referring to manifold 48a (Figure 2), in order to increase the irrigation flow through catheter 44, in step 283, the flow is first established through the first irrigation circuit 114 and the main working channel 142. In step 284, the shut-off valve 96c is opened, and the flow is established through the second irrigation circuit 118 and the secondary working channel 144 via the irrigation force port 104.

[0105] Functionally, the imbalance between the irrigation and suction flows can also be improved by increasing the irrigation flow through the catheter. Here again, if the suction flow rate exceeds the irrigation flow rate, the organ being treated may constrict, which can cause pain and injury. In this example, the ability to increase the irrigation flow rate allows the irrigation mass to be "adjusted" relative to the suction mass (for example, by configuring the endoscopic system 40 to "irrigation only"). When the irrigation mass is adjusted to or exceeds the suction mass, the irrigation flow can be returned to the baseline flow rate. This degree of freedom allows the operator to continue working even during periods when flow imbalances occur, such as when an obstruction is caused by the presence of a working device 148 in the irrigation channel.

[0106] The methods 250 shown in Figures 9A to 9C may be performed together, simultaneously, sequentially, or in any combination thereof. For example, the flow reversal method 250b or the irrigation flow increase method 250c may be performed in combination with the work device repositioning method 250a. Similarly, the flow reversal method 250b may be accompanied by the irrigation flow increase method 250c. Thus, the steps of method 250 may be combined in ways other than those illustrated and described in Figures 9A to 9C.

[0107] Referring to Figures 10 to 14, steering handles 42a to 42e according to one embodiment of the present disclosure are shown, respectively, housing the manifolds 48a to 48e of Figures 2 to 8. In this specification, steering handles are indicated by reference numeral 42 as general or collective, and by reference numeral 42 followed by a letter subscript (e.g., "steering handle 42a") as individual or specific.

[0108] The steering handle 42 comprises a housing 302 having a head assembly 304 and a base portion 306 separated by a body portion 308. The body portion 308 has a handle shaft 310, and the head portion 304, body portion 308, and base portion 306 are arranged along this handle shaft 310. The head assembly 304 is located proximal to the body portion 308, and the base portion 306 is located distal to the body portion 308. In this specification, in the context of the steering handle 42, “proximal” refers to the direction 312 toward the head assembly 304 along the catheter axis 68 and the handle shaft 310, and “distal” refers to the direction 314 toward the head assembly 304 along the catheter axis 68 and the handle shaft 310. The head assembly 304 may include a thumb lever 316 for articulating the distal end 74 of the catheter 44 and one or more push-button actuators 318 for operating feature parts of the endoscope system 40.

[0109] The base portion 306 may include a bulkhead 332 through which the main working channel input port 102 and the secondary working channel input port 106 are routed to interact with the external system 46. In some embodiments, the irrigation force port 104 and the suction port 182 extend distal to the bulkhead 332 through the base portion 306 (Figures 10 and 11), but may also be routed further through the bulkhead 332 (Figures 12-14). Optionally, the irrigation force port 104 or the suction port 182 (or both) may be configured to be compatible with a LUER tapered fitting. In some embodiments, the irrigation force port 104 or the suction port 182 (or both) may include an external valve such as a shut-off valve. The base portion 306 may include a catheter port 334 through which the catheter 44 is connected, and an electrical port 336 for routing electrical wiring.

[0110] The steering handles 42a, 42b, and 42c are equipped with a plurality of rotary two-position valve actuators 338 for operating the shut-off valve 96. In some embodiments, these valve actuators 338 extend through the base portion 306 of the housing 302. The steering handles 42c and 42d are equipped with a changeover switch actuator 360 for a changeover switch 202 illustrated with respect to manifolds 48c and 48d in Figures 4 to 7. The steering handle 42d is also equipped with a cap or plug 232 for sealing the auxiliary work channel input port 106. The steering handle 42e is equipped with a plurality of push-button two-position translational valve actuators 340 for operating the shut-off valve 96.

[0111] Referring to Figures 15 to 17, a rotary two-position valve actuator 338 according to an embodiment of the present disclosure is shown. For steering handles 42a and 42b, all shut-off valves 96 are two-position or binary valves 342, e.g., rotary shut-off valves 344. For steering handle 42c, only shut-off valves 96a and 96d are two-position valves 342. The rotary two-position valve actuators 338 and input ports 92 may be color-coded for easier identification (e.g., orange for irrigation, blue for working devices, and white for suction). Alternatively or additionally, each valve actuator 338 and / or input port 92 may be identified by printing on the housing 302.

[0112] As shown in Figures 15A to 15C and Figure 15, the rotary two-position valve actuator 338 may extend through the housing 302 and may include a lever actuator 346 for rotary operation by an operator. The lever actuator 346 is coupled to the stem 348 (Figure 15A) and may be oriented parallel to the flow direction through the flow orifice 349 of the shut-off valve 96. This flow orifice 349 is defined within the stem 348. The stem 348 is inserted into the valve body 343, which may be integrated with the housing 302 or a separate unit. In some embodiments, each lever actuator 346 includes a flange 345, which partially surrounds the stem 348 and, in cooperation with a stopper 347 formed on the valve body 343 or housing 302, limits the rotation of the rotary two-position valve actuator 338 to a fixed angle (e.g., 90 degrees as shown in Figures 15B and 15C).

[0113] In the illustrated embodiment, the manifold 48 is oriented such that the fluid circuit 110 extends substantially in the proximal direction 312 and the distal direction 314. Therefore, the illustrated shut-off valve 96 is "open" (i.e., flow-enabled orientation) when the lever actuator 346 extends substantially parallel to the proximal direction 312 and the distal direction 314 (Figure 15), and "closed" (i.e., flow-blocking orientation) when the lever actuator 346 extends substantially perpendicular to the proximal direction 312 and the distal direction 314 (Figure 16).

[0114] Alternatively, as shown in Figures 17 and 18, the shut-off valve 344 may define a tool receptacle 350 for operating the shut-off valve 96 using a tool (not shown). The tool receptacle 350 may be, for example, a slot (not shown) for inserting a flat-head screwdriver (not shown). The shut-off valve 344 having the tool slot 350 may be located inside the housing 302 and may be accessible by removing a portion of the housing 302 (see drawings) or through an access aperture (not shown) formed on the housing 302.

[0115] Referring to Figure 19, a changeover switch actuator 360 according to one embodiment of the present disclosure is shown. The changeover switch actuator 360 comprises a handle portion 362 and a stem portion 364, the stem portion 364 having a rotating shaft 366. The changeover switch actuator 360 may also comprise a valve core 368 for shut-off valves 96b, 96c, and 96e and an end bearing 368 defining a tangential groove 372 configured to receive a retaining clip 374 (Figure 30). The changeover switch actuator 360 may also comprise a cam 376. The valve core 368 defines a flow orifice 382 having a flow shaft 384. The flow shaft 384 extends perpendicular to the rotating shaft 366 and is offset outward from the rotating shaft 366.

[0116] Referring to Figure 20, the changeover switch actuator 360 is shown in an assembly according to one embodiment of the present disclosure. In Figure 20, the handle portion 362 of the changeover switch actuator 360 has been removed for clarity. The changeover switch actuator 360 is housed within a changeover switch body 386, which may be integrated with manifolds 48c, 48d. In some embodiments, the manifolds 48c, 48d include a feature portion 388 that extends outward and surrounds a cam 370 of the changeover switch actuator 360. The cam 370 interacts with the feature portion 388 to snap the changeover switch actuator 360 into one of three positions of the changeover switch 202, thereby holding the valve core 368 in a desired rotational orientation. The feature portion 388 may include a stopper 392, which the cam 370 aligns with the stopper 392 to prevent further rotation of the changeover switch actuator 360 in a given direction.

[0117] Functionally, the changeover switch actuator 360, in cooperation with the changeover switch body 386 and the feature parts 388 and 392 of the manifolds 48c and 48d, defines the three-position changeover switch 394. The positions of the three-position changeover switch 394 as shown in the figure correspond to the "irrigation only," "closed," and "irrigation + suction" configurations of the manifolds 48c and 48d.

[0118] Referring to Figures 20A to 22C, the operation of the three-position changeover switch 394 and the three-position valve 206 according to one embodiment of the present disclosure is shown. A steering handle 42c is shown in these drawings with the understanding that the same operation applies to the steering handle 42d as well. Position 1, as described above in relation to 200 and 230, is shown in Figures 20A to 20C, and corresponds to the "drench only" configuration as marked on the housing 302. In position 1, the cam 370 engages with the first of the feature portions 388 and one of the stopper feature portions 392 (Figure 20B).

[0119] The schematic cross-sections 396a–396c (collectively and generally referred to as cross-section 396) in Figures 20C, 21C, and 22C correspond to the valve core 368 within the valve changeover switch body 386. The valve core 368 in cross-section 396 shows two flow orifices 382 and 382', the flow orifice 382' being optional and indicated by a dashed line. As an example, cross-sections 396a–396c correspond to the three-position configuration of shut-off valves 96b and 96e as illustrated and described with respect to manifolds 48c and 48d. The optional flow orifice 382' is present in the case of shut-off valve 96b and absent in the case of shut-off valve 96e. In cross-section 396, the changeover switch body 386 partially defines the conduits 90 of the manifolds 48c and 48d, and these conduits 90 pass through the changeover switch body 386 at a position where they are offset outward from the rotation axis 366 of the changeover switch actuator 360 and aligned with the flow orifice 382 when the three-position valve 206 is in a flow-enabled configuration (Figure 22A).

[0120] Position 2, as described above in relation to schematic diagrams 200 and 230, is shown in Figures 21A to 21C, and corresponds to the "closed" configuration as marked on the housing 302. The cam 370 engages with the second in feature portion 388 to fix the changeover switch actuator 360 in position 2 (Figure 21B). In cross section 396b, the valve core 368 blocks the conduit 90, thereby blocking the conduit 90 and interrupting the circuit 110.

[0121] Position 3, as described above in relation to schematic diagrams 200 and 230, is shown in Figures 22A to 22C and corresponds to the "closed" configuration as marked on the housing 302. The cam 370 engages with a third of the feature portion 388 and one of the stopper feature portion 382 to fix the changeover switch actuator 360 in position 3 (Figure 22B). In section 396c, the valve core 368 either blocks or allows flow through the conduit 90 depending on whether an optional flow orifice 382' is present (Figure 20C). That is, for the shut-off valve 96b having two flow orifices 382 and 382', flow is allowed in Figure 22C. For the shut-off valve 96e having only one flow orifice 382, ​​flow is blocked in Figure 22C. The operation of the shut-off valve 96c is the reverse of the operation of the shut-off valve 96b (i.e., it is in a shut-off configuration at position 1 and in a flow-allowed configuration at position 3).

[0122] In this way, the switch actuator 360 works in cooperation with the changeover switch body 386 and the feature parts 388 and 392 of the manifolds 48c and 48d to realize the three-position valve 206 of the manifolds 48c and 48d.

[0123] Referring to Figures 23 to 26, the layout and structure of the manifold 48a are shown in the physical domain, illustrating various aspects of schematic Figure 180 according to one embodiment of the present disclosure. In Figure 23, a solid model representation 420 from the conduit 90 to the manifold 48a is shown. In Figure 24, the path from the conduit to the housing 302 is shown by a hidden line. In Figures 23 and 24, the conduit 90 of the manifold 48a is similar to the letter W, with three input ports 102, 104, and 106 located at the top of W, and an output port 94 located at the bottom tip of W. The manifold 48a is shown alone (with mounting fixtures) in Figure 25 and in an installed state in Figure 26. Also in Figures 24 to 26, the valve actuators 338 are individually identified as valve actuators 338a to 338d together with the corresponding shut-off valves 96a to 96d.

[0124] Referring to Figures 27 to 29, the layout and structure of the manifold 48b are shown in the physical domain, illustrating various aspects of schematic Figure 200 according to one embodiment of the present disclosure. Figure 27 shows a solid model representation 440 from the conduit 90 to the manifold 48b. Figure 28 shows the path from the conduit to the housing 302 as a hidden line. Figure 29 shows the manifold 48b alone. In the illustrated embodiment, the manifolds 48a and 48b include a matrix structure 424 through which the conduit 90 passes, and the matrix structure 424 supports the valve 96. The bulkhead 332, conduit 90, and matrix structure 424 may be separate units. Also in Figures 28 and 29, the valve actuators 338 are individually identified as valve actuators 338a to 338e together with the corresponding shut-off valves 96a to 96e.

[0125] With respect to manifolds 48a and 48b, the conduits 90, and specifically the work channel conduits 90a and 90d of the main work channel circuit 112 and the secondary work channel circuit 116, are characterized by gradual inflection. The conduits 90 also penetrate the bulkhead 332. Functionally, the gradual inflection of the main work channel conduit 90a of the main work channel circuit 112 and the secondary work channel conduit 90d of the secondary work channel circuit 116 prevents crimping of the work device 148 and allows for smooth insertion. The absence of sharp corners in the irrigation conduits 90b and 90c reduces pressure drops within the irrigation circuits 114 and 118. The matrix structure 424 provides manifold 48 with sufficient strength and mounting features, and facilitates three-dimensional printing manufacturing technology.

[0126] Referring to Figures 30 to 32, the layout and structure of a manifold 48d are shown in the physical domain, illustrating various aspects of schematic Figure 230 according to one embodiment of the present disclosure. Figure 30 shows a cross-sectional view 460 of conduits 90b, 90c, and 90e delivered via a three-position changeover switch 394. In Figure 31, the path of conduit 90 penetrating the housing 302 is shown by a hidden line. In Figure 32, the manifold 48d is shown alone. The manifold 48d also comprises a matrix structure 424 through which the conduit 90 penetrates, and the matrix structure 424 supports a valve 96. The bulkhead 332, conduit 90, and matrix structure 424 may be individual components.

[0127] The main working channel 142 has an inner diameter 462 and an outer diameter 464 (Figure 30A). Similarly, the secondary working channel 144 has an inner diameter 466 and an outer diameter 468. In some embodiments, one of the working channels 144, 142 has an inner diameter 466 that is larger than the inner diameter 462 of the other working channel 142, 144. In the illustrated embodiment, the secondary working channel 144 has a larger inner diameter 466, and the main working channel 142 has a smaller inner diameter 462. However, this configuration may be reversed or negated by having inner diameters 462, 466 that are substantially equivalent in size. In some embodiments, the inner diameter 466 is in the range of 1.0 mm to 1.4 mm (including 1.0 mm and 1.4 mm). In some embodiments, the inner diameter 462 is in the range of 0.6 mm to 0.8 mm (including 0.6 mm and 0.8 mm). Each outer diameter may correspond to a wall thickness in the range of 0.08 mm to 0.1 mm (including 0.08 mm and 0.1 mm). This configuration is illustrated with respect to manifold 48d, but may be implemented for any manifold 48 of this disclosure.

[0128] The main work channel conduit 90a of the main work channel circuit 112 and the sub-work channel conduit 90d of the sub-work channel circuit 116 bypass the three-position changeover switch 394 (Figure 32). Manifold 48c is similar to manifold 48d, except that manifold 48c is equipped with shut-off valves 96a and 96d above the main work channel input port 102 and the sub-work channel input port 106.

[0129] Referring to Figures 33 to 38A, the layout and structure of a manifold 48e, according to one embodiment of the present disclosure, is shown in the physical domain, as embodied in Figure 14 and in schematic Figure 240. The manifold 48e has many of the same components and attributes as the manifold 48d, and these components and attributes are identified by the same reference numerals. Instead of a rotary two-position valve actuator 338 having a changeover switch 202 or a rotary lever actuator 346, the manifold 48e has a plurality of two-position valves 342 having two-position (push / pull) translational valve actuators 340. These two-position valves 342 are slide valves 472, and in some embodiments, these slide valves 472 shut off each circuit 110 when the translational valve actuator 340 is pulled outward (away from the manifold 48e) and enable each flow circuit 110 when the translational valve actuator 340 is pushed inward (towards the manifold 48e). In some embodiments, the push / pull operation of the slide valve 472 may be reversed, that is, the slide valve 472 may be configured to allow flow by pulling the translational valve actuator 340 and to block flow by pushing the translational valve actuator 340.

[0130] Figures 34 to 38 show the translational valve actuator 340 in combinations that constitute one or more of the configurations in Table 5 for the manifold 48e. Figures 34A to 38A are cross-sectional views of the corresponding manifolds 48e in Figures 34 to 38. These cross-sectional views show the conduit 90 and the slide valve 472. With respect to Table 5, Figures 34 and 34A and 35 and 35A show the "irrigation only" combination of configurations (1) and (2), Figures 36 and 36A show the "suction only" combination of configurations (3) and (4), Figures 37 and 37A show the "irrigation + suction" combination of configurations (5) and (6), and Figures 38 and 38A show the "transition" and "closed" combinations of configurations (7) and (8).

[0131] Functionally, by using multiple two-position valves 342 instead of the changeover switch 202, the operator can obtain more combinations for operation. One example is a “suction only” configuration, which is not the configuration of the changeover switch 202 as shown herein. The larger inner diameter 466 and smaller inner diameter 462 provide greater diameter throughput to one of the working channels 144 (see drawing) or 142, penetrating and extending through the lumen 140 of the catheter 44. For a given cross-sectional area of ​​the catheter shaft 66, the assignment of the larger inner diameter 466 and smaller inner diameter 462 provides a larger clearance to one of the working channels 142, 144 than would be obtained if both inner diameters 462 and 466 were of equal diameter. The larger inner diameter 466 can provide a larger clearance or at least less interference between the working device 148 and the lumen 140, thereby making insertion of the working device 148 easier. Furthermore, the larger gap allows for better flow within the annular section defined between the working device 148 and the wall of the lumen 140. Additionally, when the larger inner diameter 462 is used in the suction circuit 116, the catheter 44 is less likely to become obstructed or blocked due to the size of the stone fragments being aspirated.

[0132] Each of the further features and methods disclosed herein can be used separately or in combination with other features and methods to realize, fabricate, and use improved devices and methods. Therefore, the combinations of features and methods disclosed herein may not be essential to the implementation of this disclosure in its broadest sense, and are disclosed merely to illustrate representative and preferred embodiments.

[0133] The following references are incorporated herein by reference in their entirety, with the exception of the definitions of claims and expressions contained herein: U.S. Provisional Patent Application No. 62 / 868,105, filed on 28 June 2019 and owned by the assignee of this application; International Patent Application “Efficient Multi-Functional Endoscopic Instrument” by Altshuler et al., filed on the same date and owned by the owner of this application; and U.S. Patent No. PCT / US19 / 42491, Irby, III, filed on 18 July 2019 and owned by the owner of this application. Any incorporation into this application by reference is limited to including no material that is inconsistent with what is expressly disclosed herein.

[0134] By reading this disclosure, various modifications to these embodiments will be apparent to those skilled in the art. For example, it will be understood to those skilled in the art that the various features described in relation to the various embodiments can be appropriately combined, decomposed, or newly combined with other features, either individually or in various combinations. Similarly, none of the features described above should be considered as limiting to the scope or intent of this disclosure, but rather as illustrative embodiments.

[0135] Those skilled in the art will understand that various embodiments may have fewer features than those illustrated in each of the embodiments described above. The embodiments described herein are not intended to be an exclusive representation of various combinations of features. Therefore, these embodiments are not mutually exclusive with respect to combinations of features, and rather the claims may include various combinations of features selected from various embodiments as understood by those skilled in the art.

[0136] Unless otherwise indicated, references to “Embodiments,” “Disclosure,” “This Disclosure,” “Embodiments of This Disclosure,” and “Embodiments of Disclosure” contained herein are references to the specification of this patent application (text and drawings, including the claims) which is not authorized prior art.

[0137] In interpreting the claims, it is clearly intended that unless specific expressions such as “means for” or “step for” are used in each claim, there will be no conflict with Section 112(f) of the U.S. Patent Act. [Explanation of Symbols]

[0138] 40 Endoscopy Systems 42 Steering wheel 42a Steering wheel 42b Steering wheel 42c Steering Wheel 42d Steering Wheel 42e Steering Wheel 44 Catheters 46 External system 48 Manifold 48a Manifold 48b Manifold 48c Manifold 48d Manifold 48e Manifold 52 Irrigation system, irrigation source 54 Suction system, suction source 56 Ablation laser systems, laser systems 62 Optical Systems 64 Imaging Systems 66 Catheter shaft 68 Central axis, catheter axis 72 Proximal end portion 74 Distal end portion, distal end 76 Distal head portion 90 Conduit 90a Main working channel conduit 90b First irrigation conduit 90c Second irrigation conduit 90d Secondary working channel conduit 90e conduit 92 input ports 94 output ports 96 Shut-off valve 96a Shut-off valve 96b Shut-off valve 96c shut-off valve 96d Shut-off valve 96e Shut-off valve 98 Compression joint 102 Main operating channel input port, fiber optic input port 104 Irrigation port, irrigation port 106 Sub-operating channel input port, suction input port 110 Fluid circuits, flow circuits 112 Main working channel circuit 114 First Irrigation Circuit 116 Sub-operating channel circuit, suction circuit 118 Second Irrigation Circuit 122 Main work channel output ports 124 secondary work channel output ports 132 First compression joint 134 Second compression joint 140 catheter lumens 142 Main Working Channel 144 Sub-working Channels 148 Working Devices 150 laser optical fibers 182 Dedicated suction port, dedicated suction input channel 184 Suction circuit 202 Changeover switch 204 Links 206 3-position valve 212 Composed of irrigation only 214 Irrigation + Suction Configuration 232 Plugs, Caps 252 Kit 254 Command 256 Tangible non-temporary media 302 Housing 304 Head Assembly, Head Section 306 Base part 308 Main body part 310 Handle shaft 312 Proximal direction 314 Distal direction 316 Thumb Lever 318 Push Button Actuator 332 Bulkhead 334 Catheter Port 336 Electrical Port 338 Valve Actuator 338a Valve Actuator 338b Valve Actuator 338c Valve Actuator 338d Valve Actuator 338e Valve Actuator 340 Translational valve actuator 342 Binary valve 343 Valve body 344 Rotary shut-off valve 345 Flange 346 Rotary Lever Actuator 347 Stopper 348 Stem 349 Flow Orifice 350 tool receptacles, tool slots 360° Changeover Switch Actuator 362 Handle section 364 Stem section 366 Rotation axes 368 Valve core, end bearing 370 Cam 372 Tangential Groove 374 Retaining clip 376 Cam 382 Flow Orifice 384 Flow axis 386 Changeover switch body, valve changeover switch body 388 Feature section 392 Stopper, Stopper Features 394 3-position selector switch 396 Cross-section 396a Cross section 396b cross section 396c cross section 420 Solid Model Representation 424 Matrix Structure 440 Solid Model Representation 462 Inner diameter 464 Outer diameter 466 Inner diameter 468 Outer diameter 472 Slide valve

Claims

1. An endoscopic surgical system, A catheter shaft having a defined central axis, wherein the central axis extends from the proximal end portion through the distal end portion of the catheter shaft, and the catheter shaft is provided with a main working channel and a secondary working channel, each extending parallel to the central axis, A steering handle housing a manifold, the manifold comprising a main work channel output port in fluid communication with the main work channel and a secondary work channel output port in fluid communication with the secondary work channel, the manifold configured such that at least one work device is fed through the main work channel via the main work channel output port, and the steering handle Three or more valves configured to control the delivery of irrigation fluid from an irrigation force port, thereby The irrigation fluid is introduced through the main working channel, or The irrigation fluid is guided through the secondary working channel. Three or more valves configured in such a way, An endoscopic surgical system equipped with [features / equipment].

2. The endoscopic surgical system according to claim 1, wherein the manifold includes a main work channel input port for a passage for the at least one work device through the main work channel via the main work channel output port.

3. The endoscopic surgical system according to claim 2, comprising at least one laser optical fiber as a working device.

4. The endoscopic surgical system according to claim 3, wherein the main working channel permanently houses the laser optical fiber.

5. The endoscopic surgical system according to claim 3, wherein one or more valves are configured to guide the irrigation fluid through the secondary working channel, and the irrigation force port is in fluid communication with the irrigation source and the secondary working channel.

6. The endoscopic surgical system according to claim 5, further comprising a suction source and a suction input port in fluid communication with the main working channel.

7. The endoscopic surgical system according to claim 1, wherein the manifold comprises the irrigation force port and the suction input port, and one or more valves are configured to block one of the secondary working channel and the primary working channel from the irrigation force port.

8. An irrigation source that is in fluid communication with the aforementioned irrigation force port, and A suction source that is in fluid communication with the aforementioned suction input port, The endoscopic surgical system according to claim 7, further comprising the above.

9. The endoscopic surgical system according to claim 8, wherein one or more valves are configured such that the main working channel is isolated from the irrigation force port, the irrigation fluid is guided through the secondary working channel, and the suction source is in fluid communication with the main working channel through the suction input port.

10. An endoscopic surgical instrument, The handlebars and A catheter extending from the handle to the distal end of the instrument, A manifold formed within the handle for distributing fluid through the first lumen and the second lumen within the catheter, From the irrigation force port to the irrigation output port, an irrigation conduit is fluidly connected to the first lumen via the manifold, A suction conduit, which is in fluid communication with the second lumen, is connected from the suction input port to the suction output port via the manifold, A irrigation fluid source coupled to the irrigation force port, A suction pump connected to the aforementioned suction input port, A fluid conduit formed within the manifold between the irrigation conduit and the suction conduit, A valve system that can switch between a first operating mode and a second operating mode, Equipped with, In the first operating mode, the irrigation fluid is guided from the irrigation fluid source to the first lumen, and the suction pump is connected to the second lumen. In the second operating mode, the irrigation fluid is guided to the second lumen to reduce occlusion, an endoscopic surgical instrument.

11. The endoscopic surgical instrument according to claim 10, further comprising a working channel through the manifold, from a working channel input port to one of the first lumen and the second lumen in the catheter.

12. The endoscopic surgical instrument according to claim 11, wherein the working channel is connected to a suction conduit in the manifold.

13. The endoscopic surgical instrument according to claim 12, further comprising a shut-off valve located in the conduit of the working channel at a position near the point where it merges with the suction channel.

14. The endoscopic surgical instrument according to claim 11, further comprising at least one working device for insertion into the working channel.

15. The endoscopic surgical instrument according to claim 14, wherein the at least one working device is selected from the group including a laser optical fiber, a basket, a guidewire, a biopsy forceps, and combinations thereof.

16. The endoscopic surgical instrument according to claim 15, further comprising a laser.

17. The endoscopic surgical instrument according to claim 10, wherein the valve system further comprises a first valve for switching the flow of irrigation fluid from the irrigation outlet port to the fluid conduit.

18. The endoscopic surgical instrument according to claim 17, further comprising a second valve for stopping the flow of suction fluid at a location near the point where the fluid conduit merges with the suction conduit.

19. The endoscopic surgical instrument according to claim 10, further comprising a switch on the handle for changing the valve system between the first mode and the second mode.

20. An endoscopic surgical instrument, The handlebars and A catheter extending from the handle to the distal end of the instrument, A first channel and a second channel formed within the catheter for moving fluid between the handle and the distal end of the instrument, An irrigation conduit extending from the irrigation force port of the handle to the first lumen, A suction conduit extending from the suction input port of the handle to the second lumen, A irrigation fluid source coupled to the irrigation force port, A suction pump connected to the aforementioned suction input port, A fluid conduit between the irrigation conduit and the suction conduit, A first valve that can be switched between a first position and a second position, wherein in the first position, an irrigation fluid is guided from the irrigation fluid source into the first lumen, and in the second position, an irrigation fluid is guided from the irrigation fluid source into the fluid conduit; In the closed position, a second valve shuts off the suction pump, Endoscopic surgical instruments equipped with [specific features / features].

21. The endoscopic surgical instrument according to claim 20, further comprising a switch on the handle for moving the first valve to the second position and for moving the second valve to the closed position.

22. The endoscopic surgical instrument according to claim 20, further comprising a controller housing the first valve and the second valve.

23. The endoscopic surgical instrument according to claim 20, further comprising a working channel conduit leading from the working channel input port of the handle to at least one of the first lumen and the second lumen in the catheter.

24. The endoscopic surgical instrument according to claim 23, wherein the working channel conduit is joined to the suction conduit.

25. The endoscopic surgical instrument according to claim 23, further comprising a shut-off valve located in the working channel conduit at a position near the point where it merges with the suction channel.

26. The endoscopic surgical instrument according to claim 23, further comprising at least one working device for insertion into the working channel.

27. ​​The endoscopic surgical instrument according to claim 26, wherein the at least one working device is selected from the group including a laser optical fiber, a basket, a guidewire, a biopsy forceps, and combinations thereof.

28. The endoscopic surgical instrument according to claim 27, further comprising a laser.

29. The endoscopic surgical instrument according to claim 20, wherein the switch is provided as a button, and when the button is released, the first valve moves to the first position and the second valve moves to the open position.

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