Endoscopic resection cap equipped with a built-in vibration separator

Abstract

To provide devices and methods that improve visibility of a target tissue to a physician during endoscopic submucosal dissection (ESD), that provide improved control of tissue dissection to decrease the risk of undesired cutting, and / or that reduce ESD procedure time.SOLUTION: A medical device for facilitating a minimally invasive surgical procedure includes a housing 12102 and an arm 12104. The housing 12102 is configured for engagement around an outer circumferential surface of an endoscope and includes a first cavity 12108. The arm 12104 includes at least one cutting surface and may be movably received in the first cavity 12108. The arm 12104 is configured to perform a first predetermined movement along at least a first plane at a predetermined frequency.SELECTED DRAWING: Figure 12A

Description

Technical Field

[0001] Cross - reference to Related Applications This application claims priority to U.S. Provisional Patent Application No. 62 / 871,450, filed on Jul. 8, 2019, the entire disclosure of which is hereby incorporated by reference herein.

Background Art

[0002] Endoscopic Submucosal Dissection (ESD) is a non - invasive technique for removing cancerous tissue or other lesions along the gastrointestinal (GI) tract. ESD can be used when the cancerous tissue or other target tissue is within the first two inner layers of the GI wall, namely the mucosal layer and the submucosal layer. The GI tract consists of four layers. That is, the innermost layer is the mucosa (which may include epithelium, lamina propria, and muscularis mucosa), beneath which is the submucosal layer, and then there is the outermost layer called the muscularis propria and adventitia. The structure of these layers varies depending on the region of the digestive system. If the target tissue extends to any of the deeper layers of the GI wall, surgical or endoscopic full - thickness resection may be necessary. The average procedure time for physicians in the Western world is about 1 - 2 hours because the physician has to carefully make many small cuts to completely dissect the area. The two major complications associated with this method are bleeding and perforation of the muscularis propria and adventitia, and the frequency of complications is quite high due to the technical difficulty of this procedure.

[0003] There are several reasons for these iatrogenic complications. First, the mucosal flap may not be lifted sufficiently during resection, which may obstruct the doctor's view, and the doctor may only have a limited view of the resection surface or may not be able to see it at all. In this situation, the doctor may make a mistake and accidentally cut a blood vessel or perforate a muscle. Second, although the resection surface is visible, the area is narrow and the submucosal fibers are close to the muscle and / or blood vessels, so the doctor has to cut through a small window. In this situation, the doctor may make a mistake and accidentally cut a blood vessel or perforate a muscle. Third, due to the limitations of the endoscope and anatomical arrangement, the doctor may not be able to assume a posture suitable for making a cut, making it difficult to reach the dissection surface. In this situation, the doctor may make a mistake and accidentally cut a blood vessel or perforate a muscle. Fourth, the existing available scalpel is operated by electrocautery by delivering high-frequency energy from an electrosurgical generator. The inherent problem associated with the use of electrocautery is the iatrogenic risk that the doctor may accidentally cut tissues such as blood vessels and muscle tissues unintentionally.

Summary of the Invention

Problems to be Solved by the Invention

[0004] Therefore, it is desirable to provide a device and method that can improve the doctor's ability to perform ESD safely. In particular, it is desirable to provide a device and method that can enhance the visibility of the target tissue by the doctor during ESD, better control tissue dissection to reduce the risk of non-target cutting, and / or shorten the treatment time of ESD.

Means for Solving the Problems

[0005] One general aspect of the present disclosure includes a medical device for facilitating minimally invasive surgery, which includes a housing configured to engage around the outer peripheral surface of an endoscope and including a first cavity, and an arm including at least one tissue dissection surface and movably received within the first cavity, the arm being configured to perform a first predetermined movement at a predetermined frequency along at least a first plane corresponding to a reciprocating movement of a proximal portion of the arm.

[0006] Another general aspect of the present disclosure includes a medical device for facilitating minimally invasive surgery, which includes a housing having a first cavity, and an arm including at least one tissue dissection surface and movably received within the first cavity, the arm including a first receiving slot and a second receiving slot, and a first connecting member extending between a first distal end and a first proximal end of the first connecting member, and a second connecting member extending between a second distal end and a second proximal end of the second connecting member, the first distal end of the first connecting member being slidably received within the first receiving slot, the second distal end of the second connecting member being slidably received within the second receiving slot, and by operation of the first and second proximal ends, the arm is configured to rotate along at least one arc with respect to the housing.

[0007] Another general aspect of the present disclosure includes a medical device for facilitating minimally invasive surgery, which includes a housing having a first cavity and a third cavity, and an arm movably received within the first cavity, the arm including a guide portion and a connecting portion, and a cam assembly rotatably received within the third cavity, the cam assembly including a cam track groove configured to slidably receive at least a portion of the guide portion, the arm being rotatably connected to a third portion of the housing through the connecting portion, and by rotation of the cam assembly, the guide portion slides along a predetermined track within the cam track groove, whereby the arm is biased to rotate within a first plane.

[0008] Other systems, methods, features, and advantages of the embodiments disclosed in this application will be apparent to those skilled in the art or will become apparent upon a detailed review of the following drawings and detailed description. All such other systems, methods, features, and advantages are intended to be included within the scope of the present invention.

[0009] This disclosure can be better understood with reference to the following drawings and description. The components in the figures are not necessarily to scale, and emphasis is placed on explaining the principles of this disclosure. However, some figures are drawn to the correct scale and can be relied upon. Further, in the figures, like reference numerals refer to corresponding parts throughout the various figures.

Brief Description of the Drawings

[0010]

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DETAILED DESCRIPTION OF THE INVENTION

[0011] Various aspects will be described below with reference to the drawings, in which like elements are generally identified by like numbers. The relationships and functions of the various elements of the aspects may be better understood by referring to the following detailed description. However, the aspects are not limited to those shown in the drawings or explicitly described below. Also, it should be understood that the drawings are not necessarily drawn to an exact scale (certain drawings are drawn to an exact scale and may be relied upon), and in some cases, conventional material configurations, assemblies, etc. that are not necessary for understanding the aspects disclosed herein may be omitted.

[0012] To facilitate understanding of the embodiments disclosed in the present application, reference is now made to the embodiments shown in the drawings and described using specific language. However, it should be understood that the scope of the present invention is not intended to be limited in any way thereby, and alternatives to the illustrated apparatus, further improvements, and other applications of the principles of the present invention as would be normally contemplated by those skilled in the art related to the technology to which the present invention pertains are also envisioned. In the present application, the term "proximal" refers generally to the direction toward the physician during a medical procedure, and the term "distal" refers generally to the direction toward the target site within the patient's body during a medical procedure. The term "configured to" is used to describe a structural limitation that requires a particular configuration in order to perform the stated function and / or interact or interface with other components, and is not used to merely describe an intended or theoretical use. Broader terms such as relational terms and "generally", "about", "substantially", etc. are understood by those skilled in the art to provide a clear and definite scope of the disclosure and / or claims. For example, the term "generally perpendicular" is understood to include not only exactly 90.00 degrees with respect to the reference point, but also those that are functionally equivalent thereto.

[0013] Certain aspects of embodiments of the medical devices disclosed in this application configured for use in minimally invasive surgery provide an endoscopic resection cap that includes a built-in vibration dissector that can be driven by a corresponding vibration system to perform a specific movement. The vibratory movement of the dissector may be used as an alternative to, or in combination with, electrocautery to perform blunt dissection of tissue. Various embodiments of the vibration dissector may be driven by various corresponding embodiments of the vibration system to perform a predetermined movement, as described and illustrated herein. Although various embodiments of the vibration dissector are described herein as cooperating with one or more corresponding embodiments of the vibration system, one of ordinary skill in the art, by referring well to this specification and the drawings, will be able to understand how various embodiments of the vibration dissector and / or any combination thereof may be driven by other embodiments of the vibration system and / or any combination thereof without undue experimentation.

[0014] An endoscopic resection cap that includes a built-in vibration dissector may be attached to an existing endoscope to facilitate difficult and time-consuming procedures such as endoscopic submucosal dissection (ESD). For the sake of brevity, various embodiments of the built-in vibration dissector disclosed in this application are described and illustrated as a vibration dissector incorporated into an endoscopic resection cap for use in ESD in the field of GI tissue resection. One of ordinary skill in the art, by referring well to the specification and drawings of this application, will be able to easily understand how the vibration dissector may be incorporated into the same or other devices for the same or other medical and / or experimental uses, and which other devices are suitable for use therewith , and will be able to understand without undue experimentation. For example, the vibration dissector may be successfully implemented for use in peroral endoscopic myotomy (POEM), gastric peroral endoscopic myotomy (G-POEM), endoscopic mucosal resection (EMR), and other procedures that require manual resection of tissue within the gastrointestinal tract.

[0015] Referring to FIGS. 1 to 10B, embodiments of an endoscopic resection cap equipped with a built-in vibration separator are shown. The endoscopic resection cap 100 may include a housing 102 having a first cavity 108, a second cavity 106, and a third cavity 110. An arm 104 including a body 142 having at least one cutting surface 125 may be movably received within the first cavity 108. Unless otherwise clearly stated, in the interpretation of this application, the term "cut" as used herein should be understood to refer not to an incision by a sharp blade of the type associated with a surgical scalpel, etc., but to a blunt tissue disruption for tissue separation. In other words, the difference is that the tissue separation referred to here removes more hydrophobic tissues such as diseased tissues of the gastrointestinal mucosa, etc., without invading or damaging the underlying muscularis propria. The second cavity 106 may be configured to engage around the outer peripheral surface of the endoscope, and it may be fixed (removably or non-removably) using, for example, friction fitting, mounting structures (adhesives, screw connectors, straps, etc.) and / or any other mounting means. The cam assembly 126 of the vibration system 124 may be rotatably received within the third cavity 110, whereby, by a second predetermined movement (e.g., rotation) of the cam assembly 126, the arm 104 may perform a first movement 128 at a predetermined frequency along at least one first plane 130.

[0016] In some embodiments, the housing 102 may include an upper portion 132 and a lower portion 114, which are interconnected at a connection surface 120 (the upper portion 132 and the lower portion 114 may be integrally formed). The upper portion 132 may include a first portion 112, a second portion 116, and a third portion 118. The third portion 118 may be movably connected to the connection surface 120 of the lower portion 114 (e.g., through a screw mechanism or other suitable mechanism), whereby the third portion 118 may move substantially vertically upward with respect to the connection surface 120 (e.g., up to 5 mm). The first cavity 108 and the third cavity may be provided by different portions of the housing 102. The second cavity 106 may extend through at least a portion of both the upper portion 132 and the lower portion 114 of the housing 102 (e.g., as shown in FIG. 4), and may be configured to receive an endoscope therein through a friction fit. The housing 102 may have a generally cylindrical upper portion 132 that extends toward a pointed end portion 188 within the lower portion 114, and the second cavity 106 extends therethrough along the side of the housing 102 (e.g., as shown in FIGS. 1-4). It should be understood that the overall configuration of the housing may vary as desired and / or necessary to accommodate the various configurations of the devices (e.g., endoscopes) coupled thereto, without departing from the scope of the present invention in such cases.

[0017] In some embodiments, the endoscopic resection cap 100 may also include one or more longitudinal lumens (e.g., longitudinal lumen 16240 as shown in FIG. 16), which are configured to receive and direct accessory tools (e.g., endoscopic grasping tools and / or dissection tools) therein. An example of an endoscopic resection cap having one or more longitudinal lumens is described in U.S. Patent Application Publication No. 2017 / 0112361, published on April 27, 2017 (Cook Medical Technologies LLC, Bloomington, Indiana, USA), the entire disclosure of which is incorporated herein by reference. In some embodiments, the accessory tool may include a suction rotary accessory tool 16300 as shown in FIG. 16A. The suction rotary ac cessory tool 16300 may include a catheter 16308 having a hole 16302 at its distal end that fits into the longitudinal lumen 16240. The catheter 16308 may have a vacuum 16306 applied to the user end, which may be rotatable by a drive system at the user end. During use, submucosal fibers may enter the hole 16302 via suction and may be stretched and disrupted by rotation of the catheter 16308. The configuration of the suction rotary accessory tool 16300 may vary as desired and / or necessary to correspond to the configuration of the longitudinal lumen 16240 of the endoscopic resection cap.

[0018] In some embodiments, the arm 104 may include a body 142 that extends between a proximal end portion 144 and a distal end portion 146 and has a first surface 138 and an opposite surface 140. One or more surfaces of at least one cutting surface 125 may be in a tooth configuration. For example, the cutting surface 125 may have a plurality of cut-out portions 208 (e.g., three cut-out portions as shown in FIG. 1) spaced apart from each other, thereby forming a plurality of discrete peeling surfaces 210 (e.g., four peeling surfaces as shown in FIG. 1). The number, configuration (e.g., shape, dimensions), and position of the plurality of cut-out portions 208 and peeling surfaces 210 may vary as desired and / or necessary to achieve a desired blunt cutting surface 125 for performing blunt peeling of tissue when the arm performs a first predetermined motion 128 (e.g., a vibrating motion), which will be described in more detail later. For example, as shown in FIG. 10A, the peeling surface 210a has a relatively flat surface of a larger dimension and may therefore be used to peel tissue when the peeling plane is relatively large. The peeling surface 210b has a relatively sharp surface of a smaller dimension and may therefore be used to peel tissue when the peeling plane is relatively small. During use, the endoscopic resection cap 100 may be oriented as desired and / or necessary so that the desired peeling surface 210 corresponds to the peeling plane of the tissue to be peeled. The blunt cutting surface 125 may provide the ability to safely cut tissue without the need for precision and caution to avoid inadvertently cutting important structures, thereby reducing the incidence of complications and treatment time. The cut-out portions 208 may include one or more recessed sharp cutting surfaces in some embodiments (not shown).

[0019] The arm 104 may also include a connection portion 134 disposed outwardly from the first surface 138 adjacent to the proximal end portion 144 of the body 142, and a guide portion 136 extending outwardly from the opposite surface 140 adjacent to the proximal end portion 144 of the body 142. Optionally, the arm 104 may also include a first extension portion 190 disposed outwardly from the opposite surface 140, spaced apart from the guide portion 136, adjacent to the proximal end portion 144 of the body 142.

[0020] The connecting portion 134 is configured and positioned to be rotatably received within a third portion 118 of the upper portion 132 (e.g., within a first groove 166 as shown in FIG. 5), whereby the arm 104 may be rotatable within the first plane 130 (e.g., as shown in FIGS. 10A and 10B). As the third portion 118 moves vertically upward with respect to the connection surface 120 of the lower portion 114, the arm 104 correspondingly extends (e.g., moves away from the connection surface 120) and retracts with respect to the lower portion 114 (e.g., moves toward the connection surface 120). Advantageously, this configuration allows for further tissue dissection as desired and / or necessary. Thus, the arm 104 may be movable between two fixed positions, namely an extended position and a retracted position, where there are positive stop stoppers to prevent over-advancement within the housing 102 and retraction positive stop stoppers to prevent trauma when inserting the endoscopic resection cap 100 into the patient's body.

[0021] Optionally, when the connecting portion 134 is rotatably received within the third portion 118, the first extension 190 is within a first portion 112 of the upper portion 132 (e.g., as shown in FIGS. 2 and 3) configured and positioned to be rotatably received within the second groove 192 so as to... Although the first extension 190 is optional, by connecting the first extension 190 and the first portion 112, the arm 104 may be better supported and stabilized during the movement of the arm. In some embodiments, the connection portion 134 and the first extension 190 may each have a substantially cylindrical configuration (e.g., as shown in FIGS. 7, 10A, and 10B) that extends generally perpendicular to the first plane 130. The configuration (e.g., shape, dimensions) and position of the connection portion 134 and the first extension 190 may vary as desired and / or necessary (e.g., to provide desired support and / or reduce friction between contacting surfaces, corresponding to the configuration and position of the body 142, the first groove 166, and the second groove 192 as shown in FIGS. 5 and 3) as long as the arm 104 is rotatably connected between the third portion 118 and the first portion 112 of the housing 102, and it should be understood that this does not depart from the scope of the present invention in this case either.

[0022] The guide portion 136 of the arm 104 is configured (e.g., cylindrical or any other suitable configuration as shown in FIGS. 7, 10A, and 10B) and positioned to be slidably received within the cam track groove 194 of the cam assembly 126 when the connection portion 134 and the first extension 190 are received within the first groove 166 and the second groove 192, respectively, which will be described in more detail later.

[0023] In some embodiments, the cam assembly 126 may be a barrel cam as shown in the drawings of the present application. However, those skilled in the art will be able to use other cam mechanisms within the scope of the present disclosure, including its claims. For example, by way of non-limiting example, plate cams, face cams, and / or other cams or gears configured to convert the movement of a proximal control element into an oscillatory movement of an arm including any sharp and / or non-sharp release surface. For the example shown in the present application, the barrel cam is shown in FIGS. 8 and 9, and the cam assembly 126 may include an upper portion 148, a lower portion 150, and an intermediate portion 152 disposed between the upper portion 148 and the lower portion 150. The upper portion 148 may have a first upper surface 154 and a first bottom surface 156, and the first bottom surface 156 may be inclined toward the first upper surface 154. The lower portion 150 may have a second upper surface 158 and a second bottom surface 160, and the second upper surface 158 may be inclined toward the second bottom surface 160.

[0024] The cam assembly 126 may also include an upper connection portion 162 that extends upward from the first upper surface 154 of the upper portion 148. The upper connection portion 162 may be configured to be rotatably connected to a second portion 116 of the upper portion 132 of the housing 102 (e.g., received within a first lumen 170 as shown in FIGS. 1 and 6). The cam assembly 126 may also include a lower connection portion 164 that extends outward from the second bottom surface 160 of the lower portion 150. The lower connection portion 164 may be configured to rotatably engage a third portion 118 of the upper portion 132 of the housing 102 (e.g., received within a first cutout 168 as shown in FIGS. 1 and 5).

[0025] In some embodiments, the upper portion 148, lower portion 150, intermediate portion 152, upper connection portion 162, and lower connection portion 164 of the cam assembly 126 may be of a substantially cylindrical configuration having a second lumen 178 extending therethrough. The second lumen 178 may be configured such that when the upper connection portion 162 is received within the first lumen 170 of the second portion 116, a second extension 182 of the second portion 116 (e.g., as shown in FIG. 6) is rotatably received within the second lumen 178. When the cam assembly 126 is positioned within the third cavity 110, the drive system 184 may be connected to the cam assembly 126 through a wire 101 extending through the first channel 122 of the lower portion 114 of the housing 102 and through at least a portion of the second lumen 178 (e.g., as shown in FIGS. 2, 3, 10A, and 10B). The drive system 184 may include any suitable type of motor disposed at the external user end of the endoscopic resection cap 100 or incorporated within the shaft of the endoscope, which is configured to generate mechanical movement and / or control a vibration system. For example, proximal movement (e.g., rotational movement) at the user end of the drive system 184 may be transmitted over the length of the wire 101 to the cam assembly 126, whereby the cam assembly 126 rotates at a predetermined frequency about the first axis 186 (e.g., as shown in FIGS. 9-10B), which is converted into a vibratory movement at a desired frequency, e.g., a frequency of about 25 Hz to about 200 Hz, at the distal end 146 via the guide member 136 and the arm. The term "about" as used herein is defined to include any value within 5% of the recited exact value, including both above and below the exact value.

[0026] In some embodiments, as shown in FIGS. 8 and 9, the upper and lower portions 148 and 150 of the cam assembly 126 may have a first outer diameter 172 in the range of about 1.5 mm to about 6 mm. The upper and lower connection portions 162 and 164 may have a second outer diameter 174 that is smaller than the first outer diameter 172 and in the range of about 1 mm to about 4 mm. The intermediate portion 152 may have a third outer diameter 176 that is smaller than the second outer diameter 174 and in the range of about 0.5 mm to about 4 mm.

[0027] The receiving / engagement portions of the first and third cavities 108 and 110, such as the first cutout 168 of the third portion 118 as shown in FIG. 5, the second cutout 180 of the first portion 112 as shown in FIG. 3, and the second extension 182 of the second portion 116 and the first lumen 170 as shown in FIG. 6, may be configured to be rotatably received with appropriate clearances such that the corresponding portions of the cam assembly 126 provide the necessary support and stability during rotation of the cam assembly 126 while minimizing friction between the respective corresponding surfaces. The configurations (e.g., shape, dimensions, arrangement) of the first, second, and third portions 112, 116, and 118 of the upper portion 132 of the housing 102 and the various portions of the cam assembly 126 may vary, for example, but not limited to, the connection surface 120, the arm 104, the second cavity 106, the configuration (e.g., shape, dimensions) and position of the first channel 122, and whether the housing 102 includes additional longitudinal lumens for receiving and orienting accessory tools therein, to meet various design needs and perform the functions described herein, and it should be understood that these do not depart from the scope of the present invention.

[0028] In some embodiments, the cam track groove 194 may be defined by a first bottom surface 156, a second top surface 158, and an outer surface 196 of the intermediate portion 152. The cam track groove 194 may be configured to slidably receive at least a portion of the guide portion 136 therein, as shown in FIGS. 9-10B, such that as the cam assembly 126 rotates about the first axis 186, the guide portion 136 of the arm 104 may slide within the cam track groove 194 along a predetermined path 198, whereby the arm 104 may be biased to perform a predetermined oscillatory motion 128 within the first plane 130 about a second axis 200 generally perpendicular to the first plane 130 and about the first axis 186. The configuration of the guide portion 136 may vary as desired and / or necessary, so long as the outer surface of the guide portion 136 engages the first bottom surface 156 and the second top surface 158 and the motion of the guide portion 136 is controlled by the rotation of the cam assembly 126, and it is understood that this also does not depart from the scope of the present invention.

[0029] For example, as shown in FIG. 9, the first bottom surface 156 of the upper portion 148 may be inclined toward the first top surface 154 at an angle β with respect to an upper plane 202 parallel to the first top surface 154. The second top surface 158 of the lower portion 150 may be inclined away from the second bottom surface 160 at an angle α with respect to a lower plane 200 parallel to the second bottom surface 160. The angles β and α may be the same or different and may be varied as desired and / or necessary to achieve different predetermined paths 198 along which the guide portion 136 of the arm 104 slides within the cam track groove 194. In some embodiments, the angle β may be from about 5 degrees to about 45 degrees, and the angle α may be from about 5 degrees to 45 degrees. It is understood that upon rotation of the cam assembly 126, the inclined surfaces of the cam track groove 194 may cause the guide portion 136 to move upward or downward along the axis 186 with respect to the lower portion 114 of the housing 102 (i.e., move along a predetermined path 198 with respect to the cam assembly 126).

[0030] The curve 199 shown in FIG. 9 represents the actual trajectory of the up-and-down movement of the guide portion 136 when the cam assembly 126 completes one rotation cycle by extending a predetermined trajectory 198 related to the cam assembly 126 into a curve, and shows the first amplitude 204 of the upward movement of the guide portion 136 and the second amplitude 206 of the downward movement of the guide portion 136 within the cam track groove 194. It should be understood that the predetermined trajectory 198 (for example, the first amplitude 204, the second amplitude 206, and the shape of the curve) may be made different by changing the angles β and α, the shape of the first bottom surface 156 of the upper portion 148, and / or the shape of the second upper surface 158 of the lower portion 150. For example, the larger the angles β and α are, the larger the realized first and second amplitudes 204 and 206 may be. The predetermined trajectory 198 may be configured in various shapes, including (but not limited to) waves of curves, sine waves, and continuous waves. The size and configuration of the surfaces 156, 158 directly affect the oscillatory movement of the arm with respect to both the arc length and frequency of the vibration related to the rotation of the cam assembly 126, including the ability to provide multiple oscillations per rotation of the cam.

[0031] As shown in FIGS. 10A and 10B, when the cam assembly 126 rotates around the first axis 186, thereby causing the guide portion 136 to move upward with respect to the lower portion 114 of the housing 102, the arm 104 may be biased to rotate counterclockwise within the first plane 130 (FIG. 10A). That is, when the cam assembly 126 rotates, the guide portion 136 of the arm 104 engages with the cam track groove 194 and may function as a cam follower by converting the rotational movement of the cam assembly 126 into an oscillatory movement of the arm 104. By disposing the cam assembly 126 at the distal end within the endoscopic resection cap 100, as opposed to disposing it at the proximal user end and losing the transmission of force through a long catheter and the transmission of force from the rotational movement at the user end, a greater mechanical advantage is obtained.

[0032] When the cam assembly 126 rotates around the first axis 186, causing the guide portion 136 to move downward with respect to the lower portion 114 of the housing 102, the arm 104 may be biased to rotate in a clockwise direction within the first plane 130 (FIG. 10B). As the cam assembly 126 continuously rotates around the first axis 186, the arm 104 may oscillate along a predetermined arc length within the first plane 130. The predetermined arc length may be made different as desired and / or necessary by changing the configuration of the cam track groove 194 (e.g., by changing the angles β and α by changing the first amplitude 204 and the second amplitude 206). For example, the larger the first and second amplitudes 204 and 206, the larger the realized arc length may be. In some embodiments, the cam track groove 194 is configured such that, upon rotation of the cam assembly 126, the arm 104 oscillates along an arc length of from about 0.5 mm to about 7.0 mm, but up to about 30 mm, within the first plane 130 in response to the interaction with the rotation of the cam assembly. The oscillation frequency of the arm 104 may also be pre-determined, for example, through a drive system 184 that oscillates at a predetermined frequency of from about 25 Hz to about 200 Hz.

[0033] Advantageously, such oscillatory motion of the blunt cutting surface 125 of the arm 104 (e.g., at a relatively high frequency along a relatively small arc length) enables the blunt dissection of the submucosal cancer tissue in various small dissection planes that are visible, eliminating the need for the physician to carefully make small cuts multiple times to completely dissect the entire area, thereby reducing the likelihood of making mistakes and accidentally cutting blood vessels or perforating muscles. The oscillatory motion of the arm 104 The blunt dissection provided by the motion also makes it possible to avoid the inherent complications associated with electrocautery, such as bleeding and perforation.

[0034] Referring to FIGS. 11 to 11A, another embodiment of an endoscopic resection cap with a built-in vibration separator is shown. The endoscopic resection cap 11100 may include a housing 11102 having an upper portion 11132 and a lower portion 11114. The housing 11102 may include a first cavity 11108 and a second cavity 11106. The first cavity 11108 may be configured and positioned such that the arm 11104 is rotatably received therein and connected through a connection portion 11134 to a third portion 11118 of the upper portion 11132. The second cavity 11106 may be configured to engage around the outer peripheral surface of the endoscope. In some embodiments, the second cavity 11106 may extend through at least a portion of both the upper portion 11132 and the lower portion 11114 of the housing 11102 (similar to the configuration shown in FIG. 4) and may be configured to receive the endoscope therein through a friction fit.

[0035] As described in more detail above, the arm 11104 may include at least one cutting surface 11125 having a plurality of cutting portions 11208 and a plurality of peeling surfaces 11210. In some embodiments, as shown in FIG. 11, the arm 11104 may include a first receiving slot 11220 and a second receiving slot 11222 on a first surface 11138. The first receiving slot 11220 and the second receiving slot 11222 may be movably connected to a first connecting member 11224 and a second connecting member 11226, respectively.

[0036] The first connecting member 11224 may extend between a first distal end 11224a and a first proximal end 11224b of the first connecting member 11224. The second connecting member 11226 may extend between a second proximal end 11226a and a second proximal end 11226b of the second connecting member 11226. The first distal end 11224a of the first connecting member 11224 may be slidably received within the first receiving slot 11220, and the second distal end 11226a of the second connecting member 11226 may be slidably received within the second receiving slot 11222, whereby, by operation of the first and second proximal ends 11224b and 11226b, the arm 11104 may rotate along at least one arc with respect to the housing 11102 within the first plane 11130. In some embodiments, the first and second connecting members 11224 and 11226 may be axially tensioned pull wires, which may be composed of a flexible stainless steel wire rope, such as a polymer composition including UHMWPE fibers, other stainless steel or metal configurations, or other polymer configurations, all of which apply to all embodiments. At least a portion of the first and second connecting members 11224 and 11226 may extend through the first and second sheaths 11228 and 11230, respectively. The first and second sheaths 11228 and 11230 may be axially compressed rigid sheaths and may be composed of a stainless steel close-wound spring having a polymer outer covering. The first and second distal ends 11224a and 11226a may each have a cap configuration (which may be composed of a polymer material), which is shaped and sized such that the first and second distal ends 11224a and 11226a may be slidably received within the first and second receiving slots 11220 and 11222, respectively, and do not come out therefrom (e.g., do not fall out) during rotation of the arm 11104.

[0037] The first and second connection members 11224 and 11226 may extend through the housing 11102, whereby their respective first and second proximal ends 11224b and 11226b extend out of the lower portion 11114 of the housing 11102 and are coupled to the vibration system 11124 to guide the rotation of the arm 11104. In some embodiments, as shown in FIG. 11A, the vibration system 11124 may include a guide member 11232 extending between a first end portion 11232a and a second end portion 11232b. The guide member 1 1232 may be composed of a polymer or metal component. The first proximal end 11224b of the first connection member 11224 may be connected to the first end portion 11232a of the guide member 11232, and the second proximal end 11226b of the second connection member 11226 may be connected to the second end portion 11232b of the guide member 11232.

[0038] In some embodiments, the vibration system 11124 may include a first post 11234 and a second post 11236, which are respectively coupled to the proximal ends of the first and second sheaths 11228 and 11230. The first and second posts 11234 and 11236 may each include an opening, which is configured to be passable respectively by the first and second proximal ends 11224b and 11 2 26 of the first and second connection members 11224 and 11226 before they are respectively connected to the first end member 11232a and the second end portion 11232b of the guide member 11232. Advantageously, the first and second sheaths 11228 and 11230 and the first and second posts 11234 and 11236 may provide support along at least a portion of their lengths to the first and second connection members 11224 and 11226 during movement. The first and second posts 11234 and 11236 and the first and second sheaths 11228 and 11230 may also be capable of defining the plane of rotation of the arm 11104 such that the arm 11104 rotates within the first plane 11130 when the guide member 11232 rotates within the first plane 11130.

[0039] The guide member 11232 may be connected to a drive system (e.g., the aforementioned drive system), whereby the guide member 11232 may be rotatable within the first plane 11130. When the guide member 11232 rotates in the clockwise direction within the first plane 11130, thereby pulling one of the first and second connection members 11224 and 11226 (e.g., the second connection member 11226 as shown in FIGS. 11 and 11A), the arm 11104 may rotate in the clockwise direction within the first plane 11130. When the guide member 11232 rotates in the counterclockwise direction within the first plane 11130, thereby pulling the other of the first and second connection members 11224 and 11226 (e.g., the first connection member 11224 as shown in FIGS. 11 and 11A), the arm 11104 may rotate in the counterclockwise direction within the first plane 11130. As described above, the vibration system 11124 and the drive system may be biased such that the arm 11104 rotates along a predetermined arc length (e.g., from about 0.5 mm to about 7.0 mm, up to about 30 mm) at a predetermined frequency (e.g., from about 25 Hz to about 200 Hz) with respect to the housing 11102. The predetermined arc length may be varied as desired and / or necessary by changing the configuration of the arm 11104 and the first and second receiving slots 11220 and 11222, in which case it does not depart from the scope of the present invention.

[0040] In some embodiments, the arm 11104 may be rotatably and pivotably connected to the third portion 11118 of the upper portion 11132 through a connection portion 11134, such that by operating the guide member 11132, one or both of the first and second connection members 11224 and 11226 may be disengaged from the first plane 11130 by pivoting within the first cavity 11108. For example, as shown in FIG. 11B, the arm 11104 may enter a second plane 11133 at an angle φ with respect to the first plane 11130 by pivoting. The angle φ may be from about 0 to about 45 degrees. In this configuration, the guide member 11132 may be rotatable within the second plane 11133, such that when the guide member 11132 rotates, the arm 11104 may rotate within the second plane 11133.

[0041] Advantageously, with this configuration, the user can set the height of the built-in vibration separator to facilitate cutting at a position closer to the tissue and can also make the edge of the cutting surface 11125 more visible. In other words, the separator rotates into the doctor's field of view (visual field). can be angled (diagonally away from the initial plane of dissection), thereby making the plane of dissection clearly visible (e.g., approaching the center of the field of view), which facilitates an accurate cut. Otherwise, the cutting surface of the dissector may be near the boundary of the destruction, where the cutting plane is not clearly visible, and the oscillatory movement of the dissector may block the physician's view to the plane of dissection, which may be a factor in an inaccurate cut. For example, as shown in FIG. 11B, when the arm 11104 pivots into the second plane 11133, the edge of the cutting surface 11125 approaches the center of the field of view 11135 of the endoscope 11139 rather than the boundary 11137 of the field of view 11135, thereby always making the plane of dissection and the blood vessel clearly visible. In addition, by pivoting the arm 11104 into various planes and being able to oscillate within various planes, the arm 11104 can interact with the tissue within various planes of dissection, including those in difficult anatomical positions. Advantageously, a certain degree of flexibility is provided that can accommodate the limitations of the endoscope, different positions of the endoscope, and various positions of the built-in oscillating dissector due to the patient's anatomical position.

[0042] Figures 12-13D show other embodiments of the endoscopic resection device 12100. FIG. 12 shows a general non-limiting endoscope 12311. This, or any endoscope, may be equipped with a removably attached endoscopic resection cap (e.g., cap 12 100 ) or may be configured together with a built-in endoscopic resection element, which uses the same type of oscillating or reciprocating movement dissection element as shown in any of the embodiments herein, explicitly including any of FIGS. 1-11B, 14-20, and 23-25. One of ordinary skill in the art will understand that in addition to the steerable shaft 12317 of the endoscope 12311 including a steering control 12313, at least one access port 12315, at least one visualization element (not shown but readily understood by those of ordinary skill in the art of endoscopy), and one or more end-viewing and / or side-viewing elements (not shown) near the distal end of the shaft, lighting, irrigation, tools, and / or drugs It will be appreciated that other structures that may be present for the passage of the agent, as well as other features known in endoscopic techniques, are included. It should be noted that the term "reciprocating motion" is used herein to refer to a motion that includes not only rotation around an axis, but also a motion regardless of the presence or absence of rotation about that axis that traverses a fixed axis. In addition to this reciprocating motion structure and function, the curvature in the longitudinal direction of the arm described later is the difference between this embodiment and that of FIG. 11, but other features are the same or otherwise interchangeable, and the motion mechanism of FIG. 11A may also be used in this embodiment.

[0043] As shown in FIGS. 12A and 12B, the endoscopic resection cap 12100 includes a housing 12102 having an upper portion 12132 and a lower portion 12114. This may also include a drain hole 12117 configured to assist in removing an object from the field of view of the endoscope. The housing 12102 may include an outer first cavity 12108 and an inner second cavity 12106. The first cavity 12108 may be configured and positioned such that the arm 12104 is received therein and is connected to reciprocate laterally through a connection pin 12134 to a third portion 12118 of the upper portion 12132. The second cavity 12106 may be configured to removably engage around the outer peripheral surface of the endoscope (or may be substantially absent in embodiments where the resection portion is integrally formed with the endoscope). In some embodiments, the second cavity 12106 may extend through at least a portion of both the upper portion 12132 and the lower portion 12114 of the housing 12102 (similar to the configuration shown in FIG. 4) and may be configured to receive the endoscope therein by friction fitting or through other releasable / removable attachment means for releasably fixing the cap to the endoscope for use as an endoscope accessory tool.

[0044] The arm 12104 may include at least one cutting surface 12125, which has a plurality of cutting portions 12208 and a plurality of peeling surfaces 12210, which will be described in more detail later. In this embodiment, the arm 12104 includes a first receiving channel 12220 and a second receiving channel 12222. The first receiving channel 12220 and the second receiving channel 1 2222 each provide a slidable passage for a first connecting member embodied as a first pull wire 12224 and a second connecting member embodied as a second pull wire 12226. FIGS. 12C-12D each show a side view and a rotated perspective view of the arm 12104, which is curved along its proximal-distal longitudinal axis and includes a curved end opposite the peeled end. The curvature of the longitudinal dimension (shown along the dashed line 12104b of the longitudinal axis as compared to the curved imaginary line 12104a) is configured to provide an effective peeling operation during the operation of the arm 12104 by orienting its distal peeled surface 12210 towards the target tissue without significantly changing from the normal alignment state within the body passageway accessing the orientation of the endoscope. The difference between the straight axis 12104b and the curvature 12104a in this embodiment of FIG. 12C (exemplary arm length is 0.48 inches and width is 0.28 inches) is represented by gap C, the radius of curvature of the figure is 2 inches, and gap C is 0.03 inches. In an embodiment, the radius of curvature can be 0.5-5 inches and the corresponding gap can be 0.005-2 inches, which may vary depending on the size of the arm. In particular, the angle is provided for the angle with respect to the target tissue, such that when the physician operates the endoscope (having a cap or an integrated dissector tool tip), the curve of the arm is directed towards the muscularis propria. This curvature provides an advantage over a straight dissector, as it allows the physician to advance the endoscope along its main axis within the active region while aiming at the correct dissection plane. In embodiments using a straight (non-adjustable as taught elsewhere in this specification) dissector, the physician has to actively tilt the endoscope having a cap (or an integrated tool tip) towards the muscularis propria to collapse the overlapping target tissue. For this, typically, multiple fine adjustments of the direction of the endoscope are required. Further, in the case of a straight / non-adjustable dissector aligned with a distal-view endoscope, the trajectory of the endoscope camera is forced towards the muscularis propria, and the arm may come into contact with the target tissue, which may limit the view of the submucosal space. Thus, the curved arm 12104 provides advantages over prior art systems and devices.

[0045] The first wire 12224 extends to and is connected to one side of the arm 12104, and the second wire 12226 extends to and is connected to the opposite side of the arm 12104. Most of the lengths of the first and second wires (not shown, between the resection portion and the proximal wire ends) may be parallel or generally parallel when the arm is in the neutral central position as shown in FIGS. 12B and 13A. Through the long stadium-shaped hole 12133 in the arm 12104 between the wires, the arm reciprocates laterally with respect to the pin 12134 (the oval hole in the figure is composed of a rectangle with parallel straight sides and semi-circular or elliptical ends, but the shape of the hole may vary within the scope of the present application, such as an ellipse, an arch shape, or other shapes that enable reciprocating motion across the pin rather than rotational motion around a simple pin, for example, other shapes of holes that allow reciprocating motion across the pin). Such an arrangement and attachment of the first and second wires and the pin are such that when the first and second proximal wires are manipulated, the arm 12104 reciprocates within the first plane 12130, whereby the dissector surface 12210 is configured to trace at least an arc 12211 with respect to the housing 12102 as shown in FIGS. 13A (at the center), 13B (the left wire is pulled, the arm 12104 moves, its distal end is at the far left, and its proximal end is at the far right), 13C (the right wire is pulled, the arm 12104 moves, its distal end is at the far right, and its proximal end is at the far left), and 13D. The arm reciprocates back and forth across the pin in response to pulling the corresponding wire, and at the same time sways back and forth, and the range of motion is limited by the relationship between the housing 12102 and the pin and the hole. As shown in FIG. 13D, which is a composite of FIGS. 13A, 13B, and 13C, the distal end face of the arm traces a flat arc for contact with the target tissue as the proximal arm end reciprocates back and forth with respect to the pin (with some rotational motion) and the distal arm end vibrates correspondingly.

[0046] FIG. 14 shows another embodiment of an endoscopic resection cap 14100 with a built-in vibration separator, which may include an arm 14104, a connection guide 14136, and a vibration system 14124. The connection guide 14136 may extend between a distal end 14136a and a proximal end 14136b connected to the arm 14104. The vibration system 14124 may include a cam assembly 14126, which has a cam surface 14194 configured to engage the proximal end 14136b of the connection guide 14136. The cam assembly 14126 may be connected to a drive system (e.g., a pulley system), whereby the cam assembly 14126 may be rotatable within a first plane 14130. In some embodiments, as shown in FIG. 14, rotation of the cam assembly 14126 within the first plane 14130 may cause the proximal end 14136b of the connection guide 14136 to move along at least a portion of the cam surface 14194, whereby, in response thereto, the arm 14104 may perform a first predetermined motion (e.g., a vibratory motion along a predetermined arc length) at a predetermined frequency, which has been described in more detail above.

[0047] FIG. 15 shows another embodiment of an endoscopic resection cap 15100 with a built-in vibration separator, and the vibration system 15124 may include a gear assembly 15126 rotatably connected to the arm 15104, whereby rotation of the gear assembly 15126 within a first plane 15130 may cause the arm 15104 to perform a first predetermined motion (e.g., a vibratory motion along a predetermined arc length) at a predetermined frequency within the first plane 15130, which has been described in more detail above. The gear assembly 15126 may be disposed within the housing of the endoscopic resection cap 15100 and may be powered by a drive system (e.g., any suitable type of motor) at the user end. In this embodiment, the arm 15104 may have a gear configuration, and the teeth of the gear of the arm 15104 may function as a peeling surface 15210.

[0048] Figures 17 to 19 show three embodiments of an arm that can be incorporated into an endoscopic resection cap for the same or different cutting purposes. As shown in FIG. 17, the arm 17104 may have a pointed cutting surface 17125 at the tip. The cutting surface 17125 may have an inverted cut / return for easier tissue gripping, whereby the arm 17104 may more efficiently break fibers and potentially shorten the treatment time. As shown in FIG. 18, the arm 18104 may have a T-shaped configuration and may have a relatively flat cutting surface 18125 and two relatively flat edges 18129. The T-shaped configuration may be able to catch tissue. The two relatively flat edges 18129 may include a cautery surface (e.g., an electrode) configured to cauterize blood vessels or fibrous tissue that cannot be detached on the relatively flat cutting surface 18125. As shown in FIG. 19, the arm 19104 may include a curved cutting surface 19125, which has one or more teeth 19210 disposed between a plurality of U-shaped cut portions. Depending on the position of the cut portions, the embodiments shown in FIGS. 17 and 19 may detach tissue with both forward (distal direction) and lateral (transverse with respect to the distal-proximal axis of these embodiments) movement, and the embodiment shown in FIG. 18 may detach tissue with forward (distal direction) movement. Additionally or alternatively, in some embodiments, the cutting surface 19125 may have a rough surface with non-uniform features, which may perform blunt detachment of tissue during vibration. It should be understood that any arm embodiment, and any variation and combination of the above-described arm embodiments, can be incorporated into an endoscopic resection cap with a corresponding vibration system to perform a predetermined vibration motion at a predetermined frequency.

[0049] The radius of rotation of the arm and the height of the teeth of the arm may vary as desired and / or necessary to achieve the desired arc length of rotation, and in that case, it does not depart from the scope of the present invention. For example, as shown in FIGS. 17 to 19, the arm (17104, 18104, 19104) may be rotatable around an axis (17141, 18141, 19141), and the radius ( (17131, 18131, 19131) is in the range of about 2.5 mm to about 10 mm. In the embodiment shown in FIG. 19, one or more teeth 19210 may have a tooth height 19143 in the range of about 0.1 mm to about 2 mm, and the arc length of the rotation of the arm 19104 may be about 0.5 mm to about 7.0 mm per vibration, and may be up to 30 mm.

[0050] The teeth of the arm may have various configurations, and it should be understood that this does not deviate from the scope of the present invention. For example, as shown in FIG. 23, the teeth 23210 may have an inlet opening 23211 to the teeth having a smaller diameter than the bottom region 23213 between the bases 23214 of the teeth, whereby each tooth helps to capture and tear the target tissue. Regarding another example, as shown in FIG. 24, the teeth 24210 may have protrusions of different heights to capture multiple tissue densities, that is, larger teeth (e.g., 24210a and 24210b) capture more porous tissue, and smaller teeth (e.g., 24210c to 24210e) capture somewhat denser tissue, but may not capture the denser healthy tissue beneath the muscularis propria. In some embodiments, as shown in FIG. 25, the edges of the teeth 25210 may be chamfered, asymmetric circular, triangular, asymmetric trapezoidal, or any suitable configuration as desired and / or required. In each of these tooth / plurality of tooth configurations, it is preferred that each cuts and / or tears only the soft target tissue (e.g., intestinal mucosa and submucosal tissue, especially when there is a lesion), and does not do so for the healthy tissue beneath or adjacent thereto (e.g., healthy blood vessels, muscle tissue).

[0051] Other embodiments of the arm and corresponding vibration system may be contemplated to effect blunt dissection of tissue. In some embodiments, as shown in FIG. 20, the arm 20104 may be a permanent magnet or attached directly to a permanent magnet. With an alternating current with an adjacent inductor 20124 (e.g., a coil wound around a ferromagnetic material), the arm 20104 may oscillate between a first state 20111 and a second state 20113. The power source and circuit configuration for the inductor 20124 may be located at the user end. This embodiment enables the arm to be incorporated as part of the vibration system, and thus obviates the need for connection components (e.g., gears, levers) that would be required if a different vibration system were used.

[0052] In some embodiments, as shown in FIG. 21, the endoscopic resection cap 21100 may include an arm 21104 (e.g., having a rotary blade configuration) behind the distal end 21117 of the cap. The distal end 21117 of the cap may include a plurality of holes 21115, whereby connective tissue can be aspirated through the holes 21115, and the arm 21104 may rotate faster than the unaided vision, and thus does not obstruct the view. This embodiment may enable blunt dissection by safely and quickly dissecting the submucosal fibers and simultaneously avoiding blood vessels by preventing blood vessels from entering through the holes 21115.

[0053] In some embodiments, the arm may include two parallel arm components, one of the arm components being fixed and the other vibrating with respect to the fixed arm component, whereby a shearing action may occur when the dynamic arm component is actuated, which will be readily understood by referring to the drawings and embodiments of the present application (for example, one of ordinary skill in the art will readily envision and understand the arrangement of a single-tooth or multi-tooth arm that operates similarly to an electric clipper for such embodiments). In some embodiments, the arm may include a polymer or metal wire, string, monofilament, mesh structure, or the like, which may be attached to a rotational mechanism, whereby the tensile stress is adjusted to overcome the viscoelasticity of the connective tissue without damaging the tissue found within muscles and arteries, operating similarly to a weed trimmer with a polymer cord. With this embodiment, the arm can perform blunt dissection without the need for a mechanism for vibratory motion. For example, as shown in FIG. 22, the dissector may be a replacement of the cap design that rotates and / or vibrates either perpendicular to the axis of rotation (left side of FIG. 22) or parallel to the axis of rotation via a cam assembly 22126 (right side of FIG. 22) of the arm 22104. In some embodiments, the dissector may include or even consist of a torque cable / tube passing through the catheter, with the arm attached to the distal end of the torque cable / tube. It may be a replacement of the cap design that rotates and / or vibrates either perpendicular to the axis of rotation (left side of FIG. 22) or parallel to the axis of rotation via a cam assembly 22126 (right side of FIG. 22) of the arm 22104. In some embodiments, the dissector may include or even consist of a torque cable / tube passing through the catheter, with the arm attached to the distal end of the torque cable / tube.

[0054] In one general aspect, there is included a medical device further including a longitudinal lumen configured to receive and direct an endoscope gripper tool, the engagement with the outer peripheral surface of the endoscope being provided by a second cavity configured to receive the endoscope therein through a friction fit.

[0055] The embodiments may include one or more of the following features. A medical device in which a first predetermined motion includes an oscillatory motion of a distal end portion of an arm, the arc length of the oscillatory motion being from about 0.5 mm to about 7.0 mm (and may be up to 30 mm), and a predetermined frequency being from about 25 Hz to about 200 Hz. A medical device in which the arm curves along the longitudinal axis of the arm. A medical device in which the arm includes an elongated hole that is reciprocally movable with respect to a pin attached to a housing. A medical device in which the vibration system includes a pull wire, each extending between a proximal end and a distal end of each pull wire, the distal end of the pull wire being attached to the arm, and when the proximal end of the pull wire is manipulated, the arm performs a first predetermined motion. A medical device in which the vibration system includes a cam assembly having a cam track groove configured to receive at least a portion of a guide portion of the arm therein, and the guide portion of the arm moves along at least a portion of the cam track groove in response to rotation of the cam assembly such that the arm performs a first predetermined motion. A medical device further including a connection guide extending between a distal end and a proximal end, the distal end of the connection guide being connected to the arm, the vibration system including a cam assembly having a cam surface configured to engage the proximal end of the connection guide, and the proximal end of the connection guide moves along at least a portion of the cam surface in response to rotation of the cam assembly such that the arm performs a first predetermined motion. A medical device in which the vibration system includes a gear assembly rotatably connected to the arm, and rotation of the gear assembly causes the arm to perform a first predetermined motion. A medical device in which the vibration system includes an inductor to which an alternating current configured to cause the arm to perform a first predetermined motion is applied.

[0056] One general aspect includes a medical device for facilitating minimally invasive surgery, which includes a housing that includes a first cavity, and an arm that includes at least one tissue dissection surface and is rotatably received within the first cavity, the arm including a first receiving slot and a second receiving slot, a first connecting member extending between a first distal end and a first proximal end of the first connecting member, and a second connecting member extending between a second distal end and a second proximal end of the second connecting member, wherein the first distal end of the first connecting member is slidably received within the first receiving slot, the second distal end of the second connecting member is slidably received within the second receiving slot, and by operation of the first and second proximal ends, the arm rotates along at least one arc with respect to the housing. Other embodiments of this aspect include corresponding computer systems, devices, and computer programs recorded on one or more computer storage devices, each configured to perform the operations of the method.

[0057] The examples may include one or more of the following features. Further including a vibration system, the vibration system includes a guide member extending between a first end portion and a second end portion, the first proximal end of the first connecting member is connected to the first end portion, the second proximal end of the second connecting member is connected to the second end portion, and the movement of the guide member causes the first and second connecting members to move and the arm to rotate with respect to the housing. The guide member is rotatable in a clockwise direction and a counterclockwise direction within a first plane, and when the guide member rotates in a clockwise direction within the first plane, thereby pulling one of the first and second connecting members, causing the arm to rotate in a clockwise direction, and when the guide member rotates in a counterclockwise direction within the first plane, thereby pulling the other of the first and second connecting members, the arm is in the first plane and counter- It rotates in the clockwise direction. A medical device in which a guide member is connected to a drive system, whereby the guide member can rotate and exit from the first plane. The arm is rotatably and pivotably connected to the third part of the housing, and the guide member, by operating the guide member, moves one or both of the first and second connecting members, and the arm enters the second plane at an angle with respect to the first plane, and by rotating the guide member, the arm rotates within the second plane. A medical device in which the first and second connecting members are fool wires. By operating the first and second proximal ends, the arm rotates along an arc length of about 0.5 mm to about 30 mm with respect to the housing at a frequency of about 25 Hz to about 200 Hz. A medical device in which the arm has one or more surfaces of a tooth configuration. The housing further includes a second cavity, and the second cavity is configured to receive an endoscope therein through a friction fit.

[0058] One general aspect includes a medical device for facilitating minimally invasive surgery, which includes a housing including a first cavity and a second cavity, an arm rotatably received within the first cavity, the arm including a guide portion and a connection portion, and a cam assembly rotatably received within the second cavity, the cam assembly including a cam track groove configured to slidably receive at least a portion of the guide portion therein, the arm being rotatably connected to the third part of the housing through a connection portion, and by rotating the cam assembly, the guide portion slides along a predetermined track within the arm track groove, whereby the arm is biased to rotate within the first plane.

[0059] An embodiment may include one or more of the following features. A medical device in which a cam track groove causes a guide portion to move up and down as the cam assembly rotates, biasing the arm to rotate in a first plane. When the cam assembly rotates, causing the guide portion to move upward, the arm is biased to rotate counterclockwise in the first plane, and when the cam assembly rotates, causing the guide portion to move downward, the arm is biased to rotate clockwise in the first plane. A medical device in which rotation of the cam assembly about a first axis causes the arm to rotate about a second axis, the first axis being generally perpendicular to the second axis. The cam assembly includes an upper portion, a lower portion, and an intermediate portion disposed between the upper portion and the lower portion, the upper portion having a first upper surface and a first bottom surface, the first bottom surface being inclined toward the first upper surface, the lower portion having a second upper surface and a second bottom surface, the second upper surface being inclined away from the second bottom surface, and the first bottom surface, the second upper surface, and the outer surface of the intermediate portion being configured such that rotation of the cam assembly causes the arm to perform a predetermined oscillatory motion in a first plane. A medical device in which the upper portion, the lower portion, and the intermediate portion have a substantially cylindrical configuration. A medical device in which the arm has one or more surfaces with a tooth configuration. A medical device in which the cam assembly is a barrel cam. A medical device in which the cam assembly is connected to a drive system such that it is rotatable about a first axis. A medical device in which a third portion of the housing is configured to move upward with respect to the lower portion of the housing. A medical device in which rotation of the cam assembly causes the arm to rotate along an arc length of about 0.5 mm to about 30 mm in a first plane at a frequency of about 25 Hz to about 200 Hz.

[0060] Although various embodiments of the present disclosure have been described, the present disclosure is not limited except in consideration of the appended claims and their equivalents. Those skilled in the art will understand that various changes and improvements may be made to the foregoing embodiments without departing from the scope of the invention defined by the appended claims, and this includes that the different arm and blade configurations shown may be interchanged between embodiments, and that removable embodiments of the resection cap may be configured as an accessory for removable attachment to the endoscope or may be included as an integral part of the endoscope. Further, the advantages described herein do not necessarily mean that there are no other advantages in the present disclosure, nor is it necessarily expected that each individual embodiment of the present disclosure will achieve all of the advantages described.

Claims

1. A medical device for facilitating minimally invasive surgery, comprising: a housing including a first cavity; and an arm including at least one tissue dissection surface and movably received within the first cavity, wherein the arm includes a guide portion at a proximal portion and a first extension spaced apart from the guide portion, the first extension being positioned to be rotatably received within a groove of the housing such that the arm is rotatable within a first plane, and a cam assembly rotates with the guide portion of the proximal portion of the arm slidably received within a helical groove of the cam assembly, thereby reciprocating the proximal portion of the arm and vibrating the arm within the first plane, and a distal end portion of the arm performs a vibratory motion synchronous with the reciprocating motion of the proximal portion of the arm; wherein the housing includes a longitudinal lumen configured to receive and direct an endoscopic grasping tool; and a second cavity configured to frictionally receive an endoscope therein, a medical device.

2. A medical device for facilitating minimally invasive surgery, comprising: a housing including a first cavity; and an arm including at least one tissue dissection surface and movably received within the first cavity, wherein the arm includes a guide portion at a proximal portion and a first portion spaced apart from the guide portion, the first portion being positioned to be rotatably supported by the housing such that the arm is rotatable within a first plane, and a cam assembly rotates with the guide portion of the proximal portion of the arm slidably engaged with the cam assembly, thereby reciprocating the proximal portion of the arm and vibrating the arm within the first plane, and a distal end portion of the arm performs a vibratory motion synchronous with the reciprocating motion of the proximal portion of the arm; wherein the housing includes a longitudinal lumen configured to receive and direct an endoscopic grasping tool; and a second cavity configured to frictionally receive an endoscope therein, a medical device.

3. (a) the arm is curved along the longitudinal axis of the arm; and (b) the arm includes a long hole that is reciprocable back and forth along the longitudinal axis of the arm and crosses a pin attached to the housing. The medical device according to claim 1 or 2, which is any one of

4. further comprising an operable endoscope shaft having control means and at least one visualization element, configured to be integrally formed with the operable endoscope shaft or removably attached to the endoscope shaft for use as an endoscope accessory tool, the medical device according to any one of claims 1 to 3.

5. The medical device according to any one of claims 1 to 4, wherein the oscillatory motion is a motion having a frequency of about 25 Hz to about 200 Hz along an arc length of about 0.5 mm to about 30 mm.

Images