Medical devices and related methods for steering, operating, and / or controlling end effectors

Abstract

The medical device includes a handle, a shaft, an end effector, and a wire. The handle includes a rotatable knob and a longitudinally movable spool. The shaft extends from the distal end of the handle. The end effector is connected to the distal end of the shaft. The wire extends from the handle through the shaft to the end effector. Rotation of the knob causes the wire to rotate independently of the shaft, and the end effector to rotate. Distal movement of the spool causes the wire to move distally independently of the shaft, and the end effector transitions between at least a first and a second form. Proximal movement of the spool biases the wire in the proximal direction. By biasing the wire proximal, the deflectable portion deflects in one or more directions.

Description

Technical Field

[0001] The present disclosure generally relates to devices and methods for steering, articulating, and / or controlling an end effector. More specifically, aspects of the present disclosure relate to devices and / or related methods for steering, articulating, and / or controlling an end effector using a single pull wire.

Background Art

[0002] For example, medical procedures such as electrosurgical incisions often involve grasping tissue (e.g., using a grasper) and excising tissue (e.g., using a cautery knife or snare). In particular, such procedures can be performed by delivering an insertion device into a subject's body through a surgical incision or through a natural anatomical opening (e.g., the mouth, vagina, or rectum) and performing a procedure or surgery at a treatment site using an auxiliary device inserted through the insertion device. The auxiliary device can be one that can be coupled to tissue and can be used, for example, to lift tissue by applying a proximal force to the tissue. The auxiliary device can include a single wire (e.g., a pull wire) used to lift tissue. However, the size (e.g., the cross-sectional dimension or diameter) of the auxiliary device can be limited by, for example, the size of the working channel of the insertion device. The auxiliary device can further include, for example, one or more other wires, cables, or other components for articulation. Thus, since the size of the pull wire for lifting tissue can be limited, the lifting strength, durability, etc. of the pull wire can be limited, which can increase the time required for the procedure, the skills or techniques required, the risk of breakage or other damage, or can decrease the effectiveness / accuracy of the procedure. Accordingly, there is a need for devices and / or methods for steering and / or articulating an end effector.

Summary of the Invention

[0003] This disclosure includes medical devices and methods for steering, articulating, and / or controlling end effectors. Each of the embodiments disclosed herein may include one or more of the features described in relation to any of the other embodiments disclosed.

[0004] In one or more examples, a medical device may include a handle, a shaft, an end effector, and a wire. The handle may include a rotatable knob and a longitudinally movable spool. The shaft may extend from the distal end of the handle. The end effector is connected to the distal end of the shaft. The wire may extend from the handle through the shaft to the end effector. Rotation of the knob may cause the wire to rotate independently of the shaft, and the end effector to rotate. Distal movement of the spool may cause the wire to move distally independently of the shaft, and the end effector may transition between at least a first and a second embodiment. Proximal movement of the spool may bias the wire proximally. By biasing the wire proximally, the deflectable portion of the shaft may deflect in one or more directions.

[0005] A medical device may include one or more of the following features: A shaft may include a deflectable portion containing multiple openings arranged in one or more longitudinally extending rows. The deflectable portion may include four longitudinally extending rows of openings spaced circumferentially around the deflectable portion. A portion of the wire may include an intermediate section containing a flat surface. The flat surface may at least partially face at least one of the rows of openings. The flat surface may be configured to face each of the four longitudinally extending rows based on the rotational position of the wire in order to deflect the deflectable portion in four directions.

[0006] The medical device may further include a biasing element positioned within a portion of the handle and biasing the distal movement of the spool. The medical device may further include a tube surrounding the proximal portion of the wire. The tube may include at least one flat outer surface for interacting with the inner portion of the knob. The end effector may include two rotatable jaws that are movable between a closed and an open configuration. The two rotatable jaws may be connected to the distal end of the wire via their respective end effector wires. The proximal end of the end effector is connected to a bushing, which may be rotatably connected to the distal end of the shaft. The distal end of the wire may include a stepped diameter portion that is larger than the proximal portion of the wire. The handle may include a handle body having a slot extending longitudinally through a portion of the handle body. A portion of the spool may be movable within the slot to control the longitudinal movement of the wire. The slot may include a narrow distal portion and a wide proximal portion. The handle may include one or more arms that partially surround the knob. The proximal end of the handle may include a ring.

[0007] In another embodiment, the medical device may include a handle, a shaft, an end effector, and a wire. The handle may include a rotatable knob and a longitudinally movable spool. The shaft may extend from the distal end of the handle. The end effector may be rotatably connected to the distal end of the shaft. The wire may extend from the handle through the shaft to the end effector. The distal portion of the wire may include a distal extension and an intermediate section including a flat surface. Rotation of the knob may cause the wire to rotate independently of the shaft, and the end effector to rotate. Distal movement of the spool may cause the wire to move distally independently of the shaft, and the end effector may transition between at least the first and second embodiments.

[0008] The medical device may include one or more of the following features: The shaft may include a deflectable portion comprising four rows of longitudinally extending openings spaced circumferentially around the deflectable portion. A flat surface may at least partially face at least one of the rows of openings, and the wire is biased proximally by the proximal movement of the spool. By biasing the wire proximally, the deflectable portion may be deflected in one or more directions. The medical device may further include a tube surrounding the proximal portion of the wire. The tube may include at least one flat outer surface for interacting with the inner portion of the knob.

[0009] In yet another embodiment, the medical device may include a handle. The handle may include a first longitudinally movable actuator and a second longitudinally movable actuator. The medical device may further include a shaft extending from the distal end of the handle. The shaft may include a deflectable portion. The deflectable portion may include a plurality of openings arranged in a longitudinally extending row. The medical device may further include an end effector connected to the distal end of the shaft. The medical device may further include a first wire extending from the handle through the shaft to the end effector. The medical device may further include a second wire extending from the handle through the shaft to the distal end of the shaft. Rotation of the shaft may cause the end effector, the first wire, and the second wire to rotate. Distal movement of the first actuator may cause the first wire to move distally independently of the shaft and the second wire, and the end effector may transition between at least the first and second embodiments. By moving the second actuator distally, the second wire can be biased distally, independently of the first wire. By biasing the second wire distally, the deflectable portion of the shaft can be deflected in one or more directions.

[0010] The medical device may include one or more of the following features: The first wire may include a cylindrical distal section configured to connect to an end effector. The second wire may include an intermediate section including a flat surface. The flat surface may at least partially face a longitudinally extending row.

[0011] Any of the examples described herein may include any combination of these features. It should be understood that both the general description above and the detailed description below are illustrative and descriptive only and do not limit the claimed invention. Where used herein, the terms “comprises,” “comprising,” “has,” “having,” “includes,” “including,” or any other variation thereof, mean non-exclusive inclusion, and it is intended that a process, method, article, or apparatus containing a list of elements may include other elements not expressly enumerated or specific to such process, method, article, or apparatus, rather than including only those elements. The term “exemplary” is used to mean “example” and not “ideal.” The term “distal” refers to the direction away from the operator / towards the treatment site, and the term “proximal” refers to the direction towards the operator. The term “about” or similar terms (e.g., “substantially”) include values ​​within + / - 10% of the stated value. [Brief explanation of the drawing]

[0012] The accompanying drawings, incorporated herein and constituting part of the present specification, illustrate examples of the present disclosure and, together with the descriptions, illustrate the principles of the present disclosure. [Figure 1] This is an illustrative perspective view of a medical device, including a magnified view of the distal portion of the medical device. [Figure 2A] This figure shows various configurations of the distal portion of the medical device shown in Figure 1. [Figure 2B] This figure shows various configurations of the distal portion of the medical device shown in Figure 1. [Figure 2C] This figure shows various configurations of the distal portion of the medical device shown in Figure 1. [Figure 2D] This figure shows various configurations of the distal portion of the medical device shown in Figure 1. [Figure 2E] This figure shows various configurations of the distal portion of the medical device shown in Figure 1. [Figure 3] Figure 1 is a partial cross-section of the proximal portion of the medical device. [Figure 4A] This figure shows the proximal portion of the medical device in Figure 1 undergoing the first operation. [Figure 4B] Figure 1 shows the distal portion of the medical device receiving a corresponding first action based on a first operation. [Figure 5A] This figure shows the proximal portion of the medical device in Figure 1 undergoing the second operation. [Figure 5B] Figure 1 shows the distal portion of the medical device undergoing a corresponding second action between the two forms based on the second operation. [Figure 5C] Figure 1 shows the distal portion of the medical device undergoing a corresponding second action between the two forms based on the second operation. [Figure 6A] This figure shows an additional configuration of the distal portion of the medical device shown in Figure 1. [Figure 6B] This figure shows an additional configuration of the distal portion of the medical device shown in Figure 1. [Figure 6C] This figure shows an additional configuration of the distal portion of the medical device shown in Figure 1. [Figure 7] This figure shows the distal portion of the medical device in Figure 1 being subjected to longitudinal manipulation. [Figure 8] Figure 1 shows the proximal portion of the medical device being subjected to rotational operation, and Figure 1 shows the distal portion of the medical device being subjected to rotational operation based on the rotation of the proximal portion. [Figure 9A] This figure shows another exemplary distal portion of a medical device. [Figure 9B] This figure shows the proximal portion of the medical device shown in Figure 9A. [Figure 10] It is a cross-sectional view of the distal portion of the medical device shown in FIG. 9A. [Figure 11] It is a view showing the deflectable portion of the shaft of the distal portion of the medical device of FIG. 9A. [Figure 12A] It is a view showing the distal portion of the medical device of FIG. 9A in two different end effector configurations. [Figure 12B] It is a view showing the distal portion of the medical device of FIG. 9A in two different end effector configurations. [Figure 13A] It is a view showing the distal portion of the medical device of FIG. 9A in two different shaft steering configurations. [Figure 13B] It is a view showing the distal portion of the medical device of FIG. 9A in two different shaft steering configurations.

MODE FOR CARRYING OUT THE INVENTION

[0013] Details are referred to the examples of the present disclosure and its aspects are shown in the accompanying drawings. Identical reference numerals are used throughout the drawings to indicate identical or similar parts as much as possible. Embodiments of the present disclosure, among other aspects, particularly improve the user's ability to steer, articulate, and / or otherwise manipulate an end effector within a subject's body during a medical procedure, reduce the need to remove an endoscope or other medical device and reintroduce it into the subject's body, contribute to treating tissue within the subject, reducing the size and / or cost of the overall device, and / or shortening the overall time of the procedure.

[0014] Figure 1 shows a medical device 100 including a proximal portion 102 and a distal portion 104. Figure 1 includes a magnified view of the distal portion 104. As shown in Figure 1, the medical device 100 includes, for example, a handle 106 in the proximal portion 102. The medical device 100 includes, for example, a shaft 108 extending from the distal end of the handle 106. The medical device 100 also includes an end effector 110 at the distal end of the shaft 108 (for example, the distal portion 104). A portion of the shaft 108 further includes, for example, a deflectable portion 112 in the distal portion 104. As will be described in detail below, the movement of various parts of the handle 106 may allow the end effector 110 to be steered, articulated, and / or manipulated, for example, with multiple degrees of freedom.

[0015] The handle 106 includes a body 114, which includes, for example, a ring 116 (e.g., a thumb ring) located at the proximal end of the body 114. The handle 106 further includes a first movable member or spool 118. The spool 118 may be an actuator and may include a recess 118A (e.g., having a relatively small cross-section) and one or more (e.g., two) protrusions or extensions 118B (e.g., having a relatively large cross-section). In these embodiments, the recess 118A can accommodate one or more fingers of the user, so that the movement of the user's fingers(s) controls the movement of the spool 118. The body 114 may include a slot 120 extending longitudinally through, for example, a portion of the body 114 from a position located distally spaced from the ring 116. A portion of the spool 118 may extend into a portion of the slot 120, thereby allowing the spool 118 to move along the slot 120 (e.g., distally and / or proximal in the longitudinal direction). In these embodiments, the slot 120 may define the range of movement of the spool 118. As will be described in detail below, the spool 118 may be movable within the slot 120, for example, in the proximal and / or distal direction, thereby controlling one or more forms of the end effector 110. Furthermore, the slot 120 may include a wide portion 120A and a tapered or narrow portion 120B. As will be described in detail below, the wide portion 120A may be located proximal to the narrow portion 120B, and the transition portion between the wide portion 120A and the narrow portion 120B contributes to supporting a biasing element 122 (Figure 3, described below) or, in other embodiments, to providing a stopping surface for the biasing element 122.

[0016] Furthermore, the handle 106 includes a second movable member or knob 124. For example, the body 114 may include a cage 126 formed by two arms 128 that partially enclose the knob 124. The knob 124 and cage 126 may be located distal to a slot 120 on the body 114. As will be described in detail below, the knob 124 may be an actuator and may be rotatable, for example, clockwise and / or counterclockwise, to control one or more forms of the end effector 110. For example, the knob 124 may be rotatable about the longitudinal axis of the medical device 100 (e.g., the central longitudinal axis).

[0017] The handle 106 may further include, for example, an end cap 130 at the distal end of the handle 106. The end cap 130 may surround the proximal end of the shaft 108. The end cap 130 contributes to connecting the shaft 108 to the handle 106. In some embodiments, the end cap 130 contributes to forming a strain relief portion of the medical device 100.

[0018] As described above, the shaft 108 includes an end effector 110 at its distal end. The end effector 110 is connected to the shaft 108 at its distal end, for example, at a connecting portion 132. As described below, the connecting portion 132 contributes to enabling the movement, operation, manipulation, or other control of the end effector 110. As illustrated, the end effector 110 may be, for example, a forceps including two jaws. However, the disclosure is not limited thereto, and the end effector 110 may be any type of end effector, instrument, tool, or other device (e.g., a gripper, snare, clip, stapler, ablation device, incision knife, suturing device, needle, knife, etc.).

[0019] Furthermore, the distal portion of the shaft 108 includes a deflectable portion 112. The deflectable portion 112 may include a tube having, for example, a plurality of grooves, slits, or openings 134 that extend along each portion of the circumference of the deflectable portion 112. For example, the deflectable portion 112 may include a plurality of openings 134. Each opening 134 of one group of openings may extend over approximately 75 degrees of the circumference of the deflectable portion 112 of the shaft 108. For example, if there are four openings 134 in one group of openings, each opening 134 may extend over approximately 60 to approximately 85 degrees, for example, approximately 75 degrees, of the circumference of the deflectable portion 112. Furthermore, multiple groups of openings 134 may be spaced longitudinally apart from adjacent groups of openings 134 along the length of the deflectable portion 112. In these embodiments, the deflectable portion 112 may include a row of multiple openings 134 that extend longitudinally. For example, if each group of openings 134 includes four or more openings 134, the deflectable portion 112 may include four longitudinally extending rows 136 of openings 134. As shown in the figure, each opening 134 in the row 136 of openings 134 is longitudinally spaced from the adjacent openings 134 in the corresponding row. However, it should be noted that the size and spacing of the openings 134 and rows 136 (such as longitudinal spacing, longitudinal width, circumferential spacing, and circumferential length) may be modified. In these embodiments, the openings 134 may be formed, for example, by laser cutting or other cutting that forms a laser cutting pattern including the rows 136 of openings 134. Furthermore, although not shown, the shaft 108 may include, for example, one or more outer layers that radially surround the deflectable portion 112. In these embodiments, one or more outer layers may be flexible so that the shaft 108 moves with the movement of the deflectable portion 112.

[0020] Figures 2A to 2E show various embodiments of the distal portion 104, including, for example, the distal end of the shaft 108, the end effector 110, and the deflectable portion 112. Figure 2A illustrates the internal connection between the shaft 108 and the end effector 110, and therefore the distal portion of the shaft 108 is shown as transparent. However, the shaft 108 may be at least partially opaque. The shaft 108 may include or radially surround a wire 138 (e.g., a pull wire or actuation wire). For example, the wire 138 may extend from a handle 106 through the shaft 108, and the wire 138 may be movable (e.g., within the shaft 108) via the operation of one or more parts of the handle 106, thereby allowing control of one or more embodiments of the distal portion 104 of the medical device 100, including, for example, the end effector 110, the deflectable portion 112, etc.

[0021] The connecting portion 132 may include a bushing or bush 140, which is substantially cylindrical and may include an undercut 142 (Figure 2B). The undercut 142 may be formed, for example, by a radial reduction in thickness along the inner portion of the bush 140, extending circumferentially along the inner portion of the bush 140. Furthermore, the proximal portion of the end effector 110 may be connected to the bush 140, for example, by welding.

[0022] Furthermore, the shaft 108 may also include, for example, a flange portion 146 or a distal extension 144 connected to the flange portion 146, particularly as shown in Figure 2C. As illustrated, the distal extension 144 may be smaller than the flange portion 146. For example, both the distal extension 144 and the flange portion 146 may be substantially circular in cross-section, and the distal extension 144 may have a smaller circumference than the flange portion 146. The flange portion 146 may be positioned within an undercut 142, for example, to rotatably connect the shaft 108 to the bush 140. For example, the distal portion 146A of the flange portion 146 may include a chamfered, inclined, or tapered surface, which helps position the flange portion 146 within the undercut 142. The flange portion 146 includes a flat proximal portion 146B, and by being positioned within the undercut 142, the flange portion 146 may contribute to connecting the bush 140 with the distal extension 144 (and thus the bush 140 with the shaft 108). In these embodiments, the distal portion of the shaft 108 may be rotatably connected to the bush 140, while the distal portion of the shaft 108 is also fixed longitudinally. That is, the bush 140 can rotate relative to the shaft 108, but the bush 140 does not move longitudinally relative to the shaft 108.

[0023] Furthermore, the wire 138 may be connected to the end effector 110, for example, via one or more end effector wires 148. One or more end effector wires 148 may extend radially within the bush 140. In these embodiments, rotation of the wire 138 rotates the end effector 110, and longitudinal movement of the wire 138 controls or operates one or more forms of the end effector 110. For example, as will be described in detail below, the wire 138 and the end effector wires 148 may be thick enough to transmit rotational motion to the end effector 110 and / or may be fixedly connected via one or more wires or other connections. Furthermore, the end effector 110 may be connected to the bush 140, which is rotatably connected to the shaft 108. Furthermore, longitudinal movement of wire 138 controls the movement of end effector wire(s) 148, thereby activating or otherwise manipulating the end effector 110. In these embodiments, as described below, the movement of wire 138 contributes to activating or otherwise controlling the end effector 110.

[0024] As shown in Figure 2A, the end effector 110 may include one or more end effector control units (e.g., end effector wires 148) or may be otherwise connected to one or more end effector control units. One or more end effector wires 148 may be operably connected to wire 138. For example, the proximal end(s) of each end effector wire 148 may be fixedly connected (e.g., directly or indirectly) to the distal end of wire 138. In these embodiments, movement of wire 138 may control the movement of one or more end effector wires 148 to, for example, open and / or close the end effector 110, or otherwise operate it. As illustrated, the end effector 110 may be a forceps and may include a pair of jaws 150A, 150B. Movement of one or more end effector wires 148 can open or close one or both of the jaw sections 150A and 150B. For example, by rotating the jaw sections 150A and 150B, the distal ends of the jaw sections 150A and 150B can be moved away from each other (e.g., open) or closer to each other (e.g., closed). In some embodiments, the medical device 100 may include, for example, one end effector wire 148 connected to one of the jaw sections 150A or 150B, and movement of the wire 138 causes the one end effector wire 148 to move, moving one of the jaw sections 150A or 150B away from the other. In other embodiments, the medical device 100 may include two end effector wires 148. In this example, one end effector wire 148 may be connected to the jaw section 150A. Another end effector wire 148 may be connected to the jaw portion 150B, so that each of the two end effector wires 148 moves in response to the movement of wire 138, causing both jaw portions 150A and 150B to move away from each other.

[0025] In some embodiments, each of the jaws 150A, 150B may include proximal legs 152A, 152B. The end effector 110 may include a proximal support 154, which may include two distally extending struts 156A, 156B forming a clevis. The proximal legs 152A, 152B may be rotatably connected to the respective struts 156A, 156B. In some embodiments, one or more portions of the end effector 110 (e.g., end effector wire 148) may be biased toward a certain configuration, for example toward the closed configuration shown in Figure 2A. Furthermore, the proximal end of the end effector 110 (e.g., the proximal end of the proximal support 154) may be connected to the bush 140, for example by welding or securely connected by other means (e.g., via snap fitting, press fitting, adhesive, etc.).

[0026] Figure 2D is a perspective view of the deflectable portion 112. Note that the deflectable portion 112 may be part of the shaft 108 (e.g., formed integrally with the shaft 108) or the deflectable portion 112 may be formed separately from the shaft 108 and then connected to the shaft 108 and / or other components of the medical device 100 during assembly. In either of these embodiments, as described above, the deflectable portion 112 includes a plurality of openings 134. The openings 134 may be arranged circumferentially and longitudinally around the deflectable portion 112. For example, the deflectable portion 112 may include a row 136 of four longitudinally extending openings 134 spaced longitudinally, with the row 136 of openings 134 arranged circumferentially around the deflectable portion 112. In other embodiments, the deflectable portion 112 may include fewer or more rows 136 of openings 134 arranged circumferentially around the deflectable portion 112, for example, one row 136, two rows 136, three rows 136, five rows 136, and so on.

[0027] Figure 2E shows the distal portion of wire 138. As shown, the distal portion of wire 138 includes a distal section 160, an intermediate section 162, and a proximal section 164. The distal section 160 may include a stepped diameter portion 160A and a cylindrical distal portion 160B, the stepped diameter portion 160A having a larger cross-sectional diameter than the cylindrical distal portion 160B. Furthermore, the intermediate section 162 has a smaller cross-section than the distal section 160 and / or the proximal section 164. The intermediate section 162 may have a semicircular (or other partially circular) cross-section. For example, the intermediate section 162 may be formed by cutting off (e.g., eccentric cutting) or otherwise removing a portion of the distal portion of wire 138. In this embodiment, the intermediate section 162 may include a flat surface 166. As described below, the flat surface 166 may be at least partially aligned with and / or opposed to one of the rows 136 of the openings 134. The intermediate section 162 may be bent by manipulating the wire 138. This is due, for example, to the stepped diameter portion 160A abutting against a portion of the shaft 108 (e.g., the distal end of the deflectable portion 112) and to the flat surface 166 being smaller or narrower than the other portion of the wire 138. Furthermore, the flat surface 166 may interact with one of the rows of the openings 134 to form an articulated joint, contributing to articulation of a portion of the distal portion 104 of the medical device 100.

[0028] In some embodiments, the proximal section 164 may extend proximal to the handle 106. For example, the proximal section 164 may be connected (i.e., directly or indirectly) to the spool 118, so that the extension and / or retraction of the proximal section 164 is controlled by the movement of the spool 118. In these embodiments, the wire 138 may be movable within the shaft 108.

[0029] Figure 3 is a partial cutaway of the proximal portion 102 of the medical device of Figure 1, including the handle 106. The handle 106 includes a spool 118 that is movable within the body 114, for example, within a portion of the slot 120. Furthermore, the handle 106 includes, for example, a spring or biasing element 122 that is at least partially located within the slot 120, where, for example, the transition portion from the wide portion 120A to the narrow portion 120B is used as the distal stop surface 120C of the biasing element 122. Alternatively, the biasing element 122 may extend distally beyond the distal stop surface 120C to another portion of the handle 106. The spool 118 may include, for example, an internal projection 170 that extends within a portion of the slot 120. In some embodiments, the internal projection 170 may be movable within the slot 120, including the wide portion 120A and the narrow portion 120B, as the spool 118 moves along the slot 120. The internal projection 170 or another portion of the spool 118 may be connected to the proximal end of the wire 138, for example, via a crimping portion 172 (e.g., a cylindrical crimping portion). The proximal end of the biasing element 122 may be connected to the distal end of the projection 170. Alternatively, the biasing element 122 may not be connected to the distal end of the projection 170, but may contact or interact with the distal end of the projection 170 as the spool 118 is advanced distally within the slot 120. The biasing element 122 may bias the spool 118 proximal. For example, as the spool 118 moves distally, the biasing element 122 is compressed, and as the distal force applied to the spool 118 is released, the biasing element 122 may bias the spool 118 proximal (e.g., to the position shown in Figure 3). In some embodiments, the biasing element 122 contributes to maintaining the end effector 110 in a closed configuration by biasing the spool 118 proximal. The closed configuration may contribute to ensuring that the end effector 110 does not damage the working channel of the insertion device (e.g., an endoscope) or damage tissue when the medical device 100 is delivered to the treatment site.

[0030] Furthermore, as shown in Figure 3, a portion of the proximal section 164 of the wire 138 may be connected to or interact with the knob 124. For example, the knob 124 may be formed from two halves connected to each other so as to surround a portion of the wire 138. In addition, a tube, for example, a hypo tube 174, may be mounted around the proximal portion of the wire 138 or otherwise arranged. The hypo tube 174 may include one or more flat outer surfaces, for example, a square cross-section having four flat outer surfaces. In some embodiments, the hypo tube 174 may extend proximal to the spool 118 and / or internal projection 170, for example, through a biasing element 122. The knob 124 may engage with the hypo tube 174 so as to surround the wire 138 and the hypo tube 174, and as the knob 124 rotates, it contributes to rotating the hypo tube 174 and the wire 138. Furthermore, although not shown, the handle 106 may include one or more braking or locking mechanisms. For example, an O-ring 176, a gasket, or other mechanism may surround a portion of the wire 138 and / or the hypo tube 174 and contribute to providing a passive brake or friction lock to help hold the wire 138 and spool 118 (and thus the end effector 110) in position relative to the handle 106. Figure 3 shows a cross-sectional view of the O-ring 176 at least partially surrounding the hypo tube 174 and the wire 138. The outside of the O-ring 176 may interact with one or more internal parts of the handle 106, such as one or more internal parts of the slot 120, as the spool 118 moves proximal or distal within the slot 120.

[0031] In these embodiments, as shown in Figures 4A and 4B, rotation of the knob 124 (e.g., clockwise or counterclockwise) can, for example, rotate the wire 138 and therefore the end effector 110 via the connection through the end effector wire 148 (e.g., clockwise or counterclockwise around the central longitudinal axis of the wire 138 and / or the central longitudinal axis of the shaft 108). For example, by rotating the knob 124 (e.g., around the central longitudinal axis of the knob 124 relative to the cage 126), the user can rotate the wire 138 and the end effector 110 (via the hypotube 174) and position the end effector 110 in orientation or otherwise at the treatment site. In these embodiments, when the user rotates the knob 124 clockwise, the wire 138 and the end effector 110 also rotate clockwise. Similarly, when the user rotates the knob 124 counterclockwise, the wire 138 and the end effector 110 also rotate counterclockwise. In these embodiments, the rotation of the knob 124, and therefore the rotation of the wire 138 and the end effector 110, is independent of the rotation of the shaft 108 and the deflectable portion 112. Although not shown, the knob 124 may include one or more internal springs or biasing elements to contribute to biasing the knob 124 to one or more neutral or relaxed positions. In these embodiments, the knob 124 allows the end effector 110 to have a first degree of freedom (e.g., clockwise rotation or counterclockwise rotation).

[0032] As shown in Figures 5A to 5C, the movement of the spool 118 can control the operation of the end effector 110. For example, longitudinal movement of the spool 118 in a first direction (e.g., distal direction) can open the jaws 150A and 150B of the end effector 110. As shown in Figure 5B, the stepped diameter portion 160A of the distal section 160 of the wire 138 may be positioned distally, for example, adjacent to the proximal end of the end effector 110. Furthermore, longitudinal movement of the spool 118 in a second opposite direction (e.g., proximal direction) can close the jaws 150A and 150B of the end effector 110. As shown in Figure 5C, the stepped diameter portion 160A of the distal section 160 of the wire 138 may be positioned proximal, for example, adjacent to the deflectable portion 112. For example, the stepped diameter portion 160A may engage with the distal end of the deflectable portion 112 or otherwise abut against it to prevent the wire 138 from moving further proximal. Furthermore, in these embodiments, the movement of the wire 138 and the resulting movement of the end effector 110 are independent of the movement of the shaft 108 and the deflectable portion 112. As previously stated, the movement of the spool 118 may be biased by a biasing element 122 (Figure 3), for example, towards a closed position. In these embodiments, the movement of the spool 118 allows the end effector 110 to have a second degree of freedom (e.g., opening and closing).

[0033] As shown in Figures 6A to 6C, further or additional movement of the spool 118 (Figure 5A) can control the position (e.g., deflection) of the distal section 104, for example, by deflecting the deflectable portion 112 to further control the position of the end effector 110. As described above, the spool 118 is connected to the proximal end of the wire 138. Movement of the spool 118 in the proximal direction can move or bias the wire 138 proximal. As described above, the wire 138 includes a stepped diameter portion 160A in the distal section 160. The stepped diameter portion 160A of the distal section 160 may abut the distal end of the shaft 108 (e.g., the distal end of the deflectable portion 112), and the intermediate section 162 may face at least a portion of the deflectable portion 112. In these embodiments, the wire 138 may be pulled back proximally, and the jaws 150A, 150B of the end effector 110 may be closed. In these embodiments, proximal movement of the spool 118 causes the deflectable portion 112 of the shaft 108 to be deflected, articulated, bent, or otherwise moved to, for example, the position indicated by the shaft 108' in Figure 6C. For example, with the stepped diameter portion 160A in contact with the distal end of the deflectable portion 112, the wire 138 may function as a steering wire, for example, because the wire 138 bends over a narrower intermediate section 162 (due to, for example, the flat surface 166). In these embodiments, tissue may be grasped using the end effector 110 and then closed (for example, by the biasing element 122). With the tissue fixed within the end effector 110, the user manipulates the spool 118 (for example, by pulling it back proximally) to deflect, articulate, flex, or otherwise move the shaft 108 and the end effector 110, for example, to lift or move the tissue.

[0034] Furthermore, the position or orientation of the wire 138 may affect the direction in which the shaft 108 moves (through the deflectable portion 112). For example, the intermediate section 162 (including the flat surface 166) may be positioned to align with different rows 136 of the opening 134 of the deflectable portion 112. In these embodiments, rotating the wire 138 to adjust the position of the intermediate section 162 also rotates the end effector 110, so that the user can set or determine the deflection direction (e.g., the position or orientation of the intermediate section 162 and the flat surface 166) before grasping tissue with the end effector 110 or otherwise manipulating it. However, in some embodiments, rotating the end effector 110 while it is connected to tissue during treatment may be desirable or permissible. Next, the wire 138 may be biased proximal by the proximal movement of the spool 118. With the jaws 150A and 150B of the end effector 110 closed, the distal extension 144 of the wire 138 is in contact with a portion of the shaft 108 (e.g., the distal end of the deflectable portion 112), so the wire 138 cannot move proximal. Instead, the wire 138 (e.g., the intermediate section 162) bends in the direction that the flat surface 166 faces. In these embodiments, the flat surface 166 faces one row 136 of the opening 134 of the deflectable portion 112, and the bending of the wire 138 causes the distal portion of the shaft 108 (e.g., the deflectable portion 112) to articulate, steer, or otherwise position the end effector 110 as well.

[0035] Furthermore, the wire 138 can be rotated (e.g., via the knob 124) such that the flat surface 166 of the intermediate section 162 aligns with (faces) another row 136 of the opening 134. For example, when the flat surface 166 is facing downward, as shown in Figure 6B, a proximal force on the wire 138 contributes to the shaft 108 (e.g., shaft 108') articulating downward, steering, or otherwise positioning. Furthermore, when the flat surface 166 is facing left, as shown in Figure 6C, a proximal force on the wire 138 contributes to the shaft 108 (e.g., shaft 108'') articulating left, steering, or otherwise positioning. Although not shown, wire 138, and therefore flat surface 166, are positioned to align with other rows 136 of the opening 134 to contribute to the articulation, steering, or other manner of positioning of the shaft 108, for example, upward or to the right. In these embodiments, wire 138 is biased proximally (for example, by spool 118) to contribute to the articulation, steering, or other manner of positioning of the shaft 108 (e.g., deflectable portion 112) and end effector 110 in various directions, for example, within a plurality of known and / or predictable planes. If there are four rows 136 of the opening 134 in the deflectable portion 112, the shaft 108 and end effector 110 can be articulated, steered, or other manner of positioning in four directions (e.g., up, down, left, and right). The number of rows of the opening 134 may correspond to the number of articulation directions. In some examples, the handle 106 may include an indicator showing the direction in which the rotational / deflectable portion 112 of the flat surface 166 deflects during operation. Furthermore, the magnitude of the proximal force or the degree to which the spool 118 is pulled back in the proximal direction may contribute to controlling the degree to which the shaft 108 and the end effector 110 are articulated, steered, or otherwise positioned.

[0036] In some embodiments, biasing the wire 138 distally may also contribute to articulating, steering, or otherwise positioning the shaft 108. For example, if the medical device 100 does not include a movable end effector but instead includes a fixed end effector (e.g., a cytology brush), moving the wire 138 distally or applying force distally may articulate, steer, or otherwise position the shaft 108 in the opposite direction to the direction in which the flat surface 166 is facing. For example, the spool 118 is advanced distally so that the distal extension 144 of the wire 138 contacts the distal end of the shaft 108. Further distal movement of the spool 118 may cause the wire 138 (e.g., the intermediate section 162) to bend in the opposite direction to the direction in which the flat surface 166 is facing. In these embodiments, when the flat surface 166 is oriented toward one row 136 (e.g., the left side) of the opening 134 of the deflectable portion 112, the bending of the wire 138 when distally biased causes the wire 138 to bend in the opposite direction (e.g., to the right side) to the row 136 of the opening 134 toward which the flat surface 166 is oriented. As described above, the bending of the wire 138 articulates, steers, or otherwise positions the distal portion of the shaft 108 (e.g., the deflectable portion 112), thereby similarly articulating, steers, or otherwise positions the end effector 110.

[0037] Furthermore, as described above, the proximal end of the biasing element 122 can be connected to the spool 118 (for example, via the internal projection 170 and / or crimping portion 172). In these embodiments, the biasing element 122 can bias the spool 118, and therefore the wire 138, toward the neutral or slack position (for example, as shown in Figure 1). In these embodiments, the operation of the wire 138 can provide the end effector 110 with third, fourth, fifth, and sixth degrees of freedom, all of which are achieved by the operation of a single wire (i.e., wire 138).

[0038] As shown in Figure 7, the distal portion 104, including the shaft 108 and the end effector 110, can be advanced distally or retracted proximally. For example, the entire medical device 100 (Figure 1) can be advanced distally or retracted proximally, for example, by the user pushing the handle 106 and / or the shaft 108 distally, pulling it proximally, or otherwise biasing or manipulating it. In this embodiment, the medical device 100, including the end effector 110, may have another (e.g., a seventh) degree of freedom.

[0039] As shown in Figure 8, the shaft 108 can be rotated, for example, clockwise and / or counterclockwise. For example, the entire medical device 100 (i.e., both the proximal portion 102 and the distal portion 104) can be rotated clockwise and / or counterclockwise, for example, by the user rotating the handle 106 (i.e., including the body 114) and / or the shaft 108. In this embodiment, the medical device 100, including the end effector 110, may have yet another (e.g., an eighth) degree of freedom.

[0040] Although not shown, in some embodiments, the distal portion of the shaft 108 may include a pre-formed section. For example, the distal portion of the shaft 108 may include a bent or arc-shaped form. In this embodiment, the shaft 108 may be delivered to the treatment site via a sheath. The sheath may be more rigid than the distal portion of the shaft 108, for example, so that the distal portion of the shaft 108 is held in a straight line while it is positioned within the sheath. Once the shaft 108 is positioned at the treatment site, the distal portion of the shaft 108 is exposed by pulling the sheath proximal. Alternatively, the shaft 108 may be delivered to the treatment site via an insertion device (e.g., through a working channel such as an endoscope, ureteroscope, or catheter), and a portion of the shaft 108 may be exposed by extending a portion of the shaft 108 distal to the insertion device. In these embodiments, the exposed portion of the shaft 108 can return to a bent or arc-shaped form based on the fact that the shaft 108 includes a pre-formed section (for example, a section for articulating, steering, or otherwise positioning the shaft 108). In these embodiments, the wire 138 can still be used to operate the end effector 110 as described above, except that the wire 138 does not have to include an intermediate section 162 having a flat surface 166, since the shaft 108 is movable on its own based on the movement of the pre-formed section and sheath.

[0041] Depending on the various configurations of the medical device 100, the end effector (i.e., the end effector 110) may be operated through at least six degrees of freedom by manipulating a single wire (i.e., wire 138). These degrees of freedom are independent of the movement of the entire medical device, as described above with respect to Figures 7 and 8, for example. As previously stated, rotation of the knob 124 allows the user to rotate the end effector 110 clockwise or counterclockwise around the longitudinal axis of the medical device 100. Furthermore, longitudinal manipulation of the spool 118 (e.g., distal to the neutral position) allows the user to operate the end effector 110 (e.g., open or close it). Furthermore, longitudinal manipulation of the spool 118 (e.g., proximal to the neutral position) allows the user to deflect, articulate, or otherwise move the distal end of the shaft 108, thereby deflecting, articulating, or otherwise moving the end effector 110 in, for example, four different directions (e.g., left, right, up, and down). As described above, the direction of deflection, articulation, or movement of the shaft 108 and the end effector 110 can be controlled based on the orientation of the wire 138, i.e., based on the orientation of the flat surface 166 relative to the row 136 of the deflectable portion 112 and the opening 134. Furthermore, the end effector 110 can be moved together with the entire medical device 100 (e.g., as shown and described with respect to Figures 7 and 8). Positioning, acting, repositioning, deflection, etc., can be performed as many times as necessary during a medical procedure. Furthermore, as described above, by manipulating the same wire (e.g., wire 138), the end effector 110 can be positioned, opened and closed, deflected, articulated, moved, or otherwise manipulated to position, grasp, lift, or otherwise reposition tissue (for example, in electrosurgical incision procedures). Since only a single wire 138 is used, the wire 138 can be made sufficiently thick, avoiding breakage, degradation, or other adverse effects that may occur when using thinner control wires.Furthermore, since only one wire 138 is used, the diameter of the shaft 108 can be reduced.

[0042] Furthermore, the various components of the handle 106 (e.g., the spool 118, the knob 124, etc.) can be operated by a single user, for example, using one or both hands (e.g., with the user's thumb positioned inside the ring 116). The handle 106 offers an ergonomic design, and the control units on the handle 106 may be units that the user is already familiar with (e.g., advancing or retracting the spool, rotating the knob, etc.). In addition, a single wire (i.e., wire 138) may allow the shaft 108 to be smaller (e.g., having a smaller cross-sectional outer shape), thereby allowing the shaft 108 to be delivered through a smaller working channel or, in other embodiments, to a smaller lumen or site within the subject's body. For example, the shaft 108 may have a cross-sectional diameter or outer shape of approximately 2.2 mm, and the shaft 108 may be delivered through a working channel having a cross-sectional diameter or outer shape of approximately 2.8 mm.

[0043] Figures 9A to 13B show additional exemplary distal portions of a medical device 200, similar to the medical device in Figure 1, for example. The embodiments shown in Figures 9A to 13B may include two independent pull wires for independent articular motion and steering functions. Distributing articular motion and steering functions between two independent wires may contribute to improved ergonomics for the operator. Ergonomics may be improved, for example, by reducing the force required to actuate the two wires and by increasing the number of articular motion modes of the jaw and end effector available to the operator.

[0044] Figure 9B shows the proximal portion of the medical device shown in Figure 9A. In some embodiments, two wires (e.g., a first wire 238 and a second wire 242) may be operably connected to different actuators of the handle 206. For example, wire 238 may be operably connected to actuator 217, and wire 242 may be operably connected to actuator 219. Actuators 217 and 219 may each be the same type of actuator (e.g., a spool, a finger ring, etc.), but this is merely illustrative, and other known actuator configurations are also included within the scope of this disclosure. The handle 206 includes a body 114, which includes, for example, a ring 216 (e.g., a thumb ring) at the proximal end of the body 214. The user can rotate the ring 216 to rotate the body 214, shaft 208, wire 238, end cap 230, wire 242, and end effector 110, all of which may rotate together. Furthermore, the handle 206 may include, for example, an end cap 230 at its distal end. The end cap 230 may surround the proximal end of the shaft 208. The end cap 230 may contribute to connecting the shaft 208 to the handle 206. In some embodiments, the end cap 230 may contribute to forming a strain relief portion of the medical device 100.

[0045] Figures 9A to 10 show various embodiments of the distal portion 204 of the shaft 208, including, for example, the distal end of the shaft 208, the end effector 110, and the deflectable portion 212. Figure 9A is a perspective view of the distal portion 204, and Figure 10 is a longitudinal cross-sectional view of the distal portion 204. Figure 10 illustrates the internal connection between the shaft 208 and the end effector 110. The shaft 208 may include, for example, a first wire 238 and a second wire 242, or may otherwise be radially enclosed, which may be a pull wire and / or actuation wire, respectively. For example, the first wire 238 (and the second wire 242) extends from the handle 206 through the shaft 208, and the first wire 238 (and the second wire 242) may be movable (for example, within the shaft 208) via the operation of one or more parts of the handle 206, thereby allowing control of one or more aspects of the distal portion 204 of the medical device 200, including, for example, the end effector 110, the deflectable portion 212, etc.

[0046] Referring here to Figure 9A, the shaft 208 may include a deflectable portion 212. The deflectable portion 212 may include a tube having, for example, a plurality of grooves, slits, or openings 234 that extend along each portion of the circumference of the deflectable portion 212. The shaft 208 may be configured to house a first wire 238 (used for the articulation of the jaws 150A and 150B) and a second wire 242 (used for the articulation of the deflectable portion 212).

[0047] The deflectable portion 212 may include a plurality of circumferentially arranged openings 234 in only a portion (circumferentially) of the deflectable portion 212. Referring to Figure 11, each opening 234 may extend over approximately 180 to approximately 330 degrees, for example, approximately 270 degrees, of the circumference of the deflectable portion 212 of the shaft 208. In contrast to the openings 134 of the deflectable portion 212 illustrated in Figure 2D, the openings 234 or deflectable portion 112 are provided over a circumferential range of the shaft 208 that is relatively larger than the non-perforated portion (e.g., the portion without the openings 234) 240 of the shaft 208. For example, the non-perforated portion 240 may extend over approximately 90 degrees and, more generally, may be formed by the (circumferential) portion of the shaft 208 that does not have the openings 234. The openings 234 may form a single longitudinally extending row 236. However, in some embodiments, the opening 234 may form two or more rows 236. For example, two rows 236 may be formed by the opening 234, each occupying approximately 135 degrees of the deflectable portion 212.

[0048] As shown in Figure 11, each opening 234 in the row 236 is spaced longitudinally apart from adjacent openings 234 in the row 236. However, it should be noted that the size and spacing of the openings 234 and the row 236 (e.g., longitudinal spacing, longitudinal width, circumferential spacing, circumferential length) can be modified. In these embodiments, the openings 234 may be formed, for example, by laser cutting or other cutting that forms a laser cutting pattern including the row 236 of openings 234. Furthermore, although not shown, the shaft 208 may include, for example, one or more outer layers radially surrounding the deflectable portion 212. In these embodiments, the one or more outer layers may be flexible so that the shaft 208 moves in conjunction with the movement of the deflectable portion 212 (e.g., via the second wire 242). The non-perforated portion 240 may be more resistant to bending (e.g., more rigid, harder, and / or less flexible) compared to the circumferential portion of the shaft 208 occupied by the row 236 and the opening 234. Note that various other ratios are possible between the non-perforated portion 240 and the circumferential portion of the deflectable portion 212 occupied by the row 236 (e.g., the opening 234), e.g., 1:1 (e.g., the angle occupied by the non-perforated portion 240 and the row 236 is 180 degrees).

[0049] Figure 9A shows the end effector 110, jaws 150A and 150B, legs 152A and 152B, distally extending supports 156A and 156B, end effector wire(s) 148, and proximal support 154. The end effector wire 148 may be connected to a first wire 238 (shown in more detail in Figure 10). The end effector 110 may be operably connected to the distal portion 204 (including the deflectable portion 212) of the shaft 208. Longitudinal movement of the first wire 238 causes the end effector wire 148 to move, thereby opening and closing the jaws 150A and 150B of the end effector 110. In these embodiments, as described below, the movement of the first wire 238 contributes to operating or otherwise controlling the end effector 110.

[0050] As previously mentioned, Figure 10 shows cross-sectional views of the shaft 208, the first wire 238, and the second wire 242. As shown, the distal portion of the first wire 238 may include a distal section 260, an intermediate section 262, and a proximal section 264. The second wire 242 may include a distal section 260', an intermediate section 262', and a proximal section 264'.

[0051] With respect to the first wire 238, the distal section 260 may include a cylindrical distal section 260B, which has a larger cross-sectional diameter than the flat surface 266 of the intermediate section 262 and / or the proximal section 264. The intermediate section 262 may include a semicircular (or other partially circular) cross-section that forms a D-shaped cross-sectional shape with a flat surface 266. For example, the intermediate section 262 may be formed by cutting off (e.g., eccentric cutting) or otherwise removing a portion of the distal portion of the first wire 238. The cylindrical distal section 260B may be connected to the end effector wire 148, so that the longitudinal movement of the first wire 238 applies a longitudinal force to the end effector wire 148, assisting in opening and closing the end effector 110.

[0052] With respect to the second wire 242, the intermediate section 262' may include a semicircular (or other partially circular) cross-section that forms a D-shaped cross-sectional shape having a flat surface 266'. For example, the intermediate section 262' may be formed by cutting off (e.g., eccentric cutting) or otherwise removing a portion of the distal portion of the second wire 242. In this embodiment, the intermediate section 262' may include a flat surface 266'. As described below, the flat surface 266' may be at least partially aligned with and / or opposed to a portion of the row 236 of the openings 234. The intermediate section 262' may be bent by operation of the second wire 242. This is due, for example, to the distal section 260' abutting against a portion of the shaft 208 (e.g., the distal end of the deflectable portion 212) and to the flat surface 266' being smaller or narrower than the other portion of the second wire 242. Furthermore, the flat surface 266' may interact with the opening 234 to form an articulated joint, contributing to articulation of a portion of the distal portion 204 of the medical device 100. In some embodiments, the second wire 242 may be attached to the shaft 208 (e.g., the deflectable portion 212) or otherwise operably connected. Furthermore, the second wire 242 (and the first wire 238) may be rotatable. As previously stated, the direction in which the flat surface 266' faces when operating the second wire 242 (e.g., when moving or biasing it proximal or distal) may contribute to controlling the direction in which the shaft 208 (e.g., the deflectable portion 212) bends. Furthermore, as described above with respect to the medical device 100, the shaft 208 (e.g., the deflectable portion 212) may be rotatable (e.g., together with the handle 206) to further control the bending direction of the shaft 208 (e.g., the deflectable portion 212).

[0053] Figures 12A and 12B illustrate the articulation or movement of the end effector 110 due to the movement of the first wire 238. As shown in Figure 12A, the end effector 110 may include one or more end effector control units (e.g., end effector wires 148) or be otherwise connected to one or more end effector control units. One or more end effector wires 148 may be operably connected to the first wire 238. For example, the proximal end(s) of each end effector wire 148 may be fixedly connected (e.g., directly or indirectly) to the distal section 260' of the first wire 238. In these embodiments, the movement of the first wire 238 may control the movement of one or more end effector wires 148 to, for example, open and / or close the end effector 110, or otherwise operate it. As shown in the figure, the end effector 110 may be a forceps and may include a pair of jaws 150A, 150B. By moving one or more end effector wires 148, one or both of the jaws 150A, 150B may be opened or closed, for example, by rotating the jaws 150A, 150B, the distal ends of the jaws 150A, 150B may be moved away from each other (e.g., open) or closer to each other (e.g., closed). In some embodiments, the medical device 200 may include, for example, one end effector wire 148 connected to one of the jaws 150A or 150B, and by moving the first wire 238, the one end effector wire 148 moves, causing one of the jaws 150A or 150B to move away from the other jaw. In other embodiments, the medical device 200 may include two end-effector wires 148. In this example, one end-effector wire 148 may be connected to the jaw portion 150A. Another end-effector wire 148 may be connected to the jaw portion 150B, so that each of the two end-effector wires 148 moves in response to the movement of the first wire 238, causing both the jaw portions 150A and 150B to move away from each other.The end effector 110 is opened by pushing the first wire 238 proximally (shown in Figure 12A), and the end effector 110 is closed by pulling the first wire 238 proximally (shown in Figure 12B).

[0054] Figures 13A to 13B show the deflection, steering, or movement of the deflectable portion 212 by the movement of the second wire 242. As shown in Figures 13A to 13B, further or additional movement of the second wire 242 (shown in Figure 10) can control the position (e.g., deflection) of the distal portion 204, for example, by deflecting the deflectable portion 212 to further control the position of the end effector 110. As previously stated, the second wire 242 is connected to the distal end 209 of the shaft 208 via the distal section 260'. Movement of the second wire 242 in the proximal direction can cause the second wire 242 to move or be biased proximal. As described above, the second wire 242 (e.g., the distal section 260B) may contact the distal end 209 of the shaft 208 (e.g., the distal end of the deflectable portion 212), and the intermediate section 262 may face at least a portion of the deflectable portion 212. Proximal movement of the second wire 242 deflects, articulates, bends, or otherwise moves the deflectable portion 212 of the shaft 208 to, for example, the position indicated by the shaft 208' in Figure 13A. For example, when the second wire 242 is in contact with the distal end of the deflectable portion 212, the second wire 242 may function as a steering wire, for example, because the second wire 242 bends over a narrower intermediate section 262' (for example, due to a flat surface 266). The user manipulates the second wire 242 (for example, by pulling it back proximally) to deflect, articulate, steer, bend, or otherwise move the shaft 208 and the end effector 110. Another example of articulation of the shaft 208' is shown in Figure 13B.

[0055] In the embodiments shown in Figures 9 to 13, the operator can rotate both the end effector 110 and the intermediate section 262' (e.g., the flat surface 266') by rotating the shaft 208. Furthermore, the position or orientation of the second wire 242 can influence the direction in which the shaft 208 moves (via the deflectable portion 212) by deflecting, articulating, steering, bending, or otherwise. For example, the intermediate section 262' (including the flat surface 266') may be positioned to align with different portions of the opening 234 of the deflectable portion 212. As an example, the operator can rotate the shaft 208 so that the intermediate section 262' faces the 6 o'clock position, thereby causing distal movement of the second wire 242 to articulate the deflectable portion 212 toward (and possibly beyond) the 6 o'clock position (as shown in Figure 13A). Similarly, the operator can rotate the shaft 208 so that the intermediate section 262' faces the 12 o'clock position, thereby causing distal movement of the second wire 242 to articulate the deflectable portion 212 toward (and possibly beyond) the 12 o'clock position (as shown in Figure 13B). It will be understood that the rotation of the shaft 208 rotates the end effector 110, the first wire 238, and the second wire 242. Thus, the rotation of the shaft 208 allows the deflection direction (e.g., the position or orientation of the intermediate section 262' and the flat surface 266') to be determined before grasping tissue with the end effector 110 (via the movement of the first wire 238) or otherwise manipulating it.

[0056] Next, the second wire 242 can be biased proximal by proximal movement of the second wire 242. The second wire 242 (e.g., intermediate section 262') bends in the direction that the flat surface 266 faces. In these embodiments, the flat surface 266' faces the row 236 of the opening 234 of the deflectable portion 212, and the bending of the second wire 242 causes the distal portion of the shaft 208 (e.g., the deflectable portion 212) to articulate, steer, or otherwise position the end effector 110 as well.

[0057] In some examples, the handle 206 may include an indicator showing the rotational direction of the flat surface 266' or the direction in which the deflectable portion 212 deflects when the second wire 242 is in operation. Furthermore, the magnitude of the proximal force or the extent to which the second wire 242 is pulled back proximal or extended distally may contribute to controlling the extent to which the shaft 208 and end effector 110 are articulated, steered, or otherwise positioned.

[0058] It will be understood that the operation of the end effector 110 and the articulation of the deflectable portion 212 can be independent of each other. For example, the user can activate (e.g., open) the end effector 110 by pushing the first wire 238 distally, and at the same time articulate the deflectable portion 212 in a first direction by pushing the second wire 242 distally (shown in Figure 13A). In another example, the user can activate (e.g., close) the end effector by pulling the first wire 238 proximal, and at the same time articulate the deflectable portion 212 in a second direction by pulling the second wire 242 proximal (shown in Figure 13B).

[0059] The principles of this disclosure are described herein with reference to exemplary examples for specific uses, but it should be understood that this disclosure is not limited thereto. Those skilled in the art and those with access to the teachings provided herein will recognize that all additional modifications, applications, and substitutions of equivalents are within the scope of the examples described herein. Accordingly, the invention should not be considered limited by the foregoing description.

Claims

1. It is a medical device, A handle including a rotatable knob and a spool that can move in the longitudinal direction, A shaft extending from the distal end of the handle, An end effector connected to the distal end of the aforementioned shaft, A wire extending from the handle through the shaft to the end effector, The rotation of the knob causes the wire to rotate independently of the shaft, and the end effector to rotate. As the spool moves distally, the wire moves distally independently of the shaft, and the end effector transitions between at least the first and second forms. A medical device wherein the wire is biased proximally by the proximal movement of the spool, and the deflectable portion of the shaft is deflected in one or more directions as a result of the wire being biased proximally.

2. The medical device according to claim 1, wherein the shaft includes a deflectable portion having a plurality of openings arranged in one or more longitudinally extending rows.

3. The medical device according to claim 2, wherein the deflectable portion includes a row of four longitudinally extending openings arranged circumferentially around the deflectable portion.

4. The medical device according to claim 3, wherein a portion of the wire includes an intermediate section having a flat surface.

5. The medical device according to claim 4, wherein the flat surface is at least partially opposite to at least one of the rows of openings.

6. The medical device according to claim 5, wherein the flat surface is configured to face each of the four rows of longitudinally extending openings based on the rotational position of the wire, in order to deflect the deflectable portion in four directions.

7. The medical device according to any one of claims 1 to 6, further comprising a biasing element disposed within a portion of the handle and biasing the distal movement of the spool.

8. The medical device according to any one of claims 1 to 7, further comprising a tube surrounding the proximal portion of the wire, wherein the tube includes at least one flat outer surface for interacting with the internal portion of the knob.

9. The medical device according to any one of claims 1 to 8, wherein the end effector includes two rotatable jaw portions that can move between a closed configuration and an open configuration.

10. The medical device according to claim 9, wherein the two rotatable jaw portions are connected to the distal ends of the wires via their respective end-effector wires.

11. The medical device according to claim 10, wherein the proximal end of the end effector is connected to a bushing, and the bushing is rotatably connected to the distal end of the shaft.

12. The medical device according to any one of claims 1 to 11, wherein the distal end of the wire includes a stepped diameter portion that is larger than the proximal portion of the wire.

13. The medical device according to any one of claims 1 to 12, wherein the handle includes a handle body, the handle body is provided with a slot extending longitudinally through a portion of the handle body, and a portion of the spool is movable within the slot to control the longitudinal movement of the wire, the slot includes a narrow distal portion and a wide proximal portion.

14. The medical device according to any one of claims 1 to 13, wherein the handle includes one or more arms that partially surround the knob.

15. The medical device according to any one of claims 1 to 14, wherein the proximal end of the handle includes a ring.

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