Endoscope with a multi-angular viewing direction

Abstract

To provide a medical device having multiple visual fields for providing multiple operation directions, and including an adjustable lifting tool.SOLUTION: A medical device includes a shaft, an image sensor, a lifting tool, an operation mechanism, and an instrument. In a first posture of the lifting tool, a distal end opening is positioned so as to allow the instrument to extend from a front opening of the shaft, and so as not to allow the instrument to extend from a lateral opening of the shaft. In a second posture of the lifting tool, the distal end opening is positioned so as to allow the instrument to extend from the lateral opening of the shaft, and so as not to allow the instrument to extend from the front opening of the shaft, and is positioned so that part of the shaft covers at least part of the distal end opening of the lifting tool to block it. The shaft includes a recessed part of the size setting and shape to receive part of the instrument. The recessed part is press-fitted to a part of the instrument, and is configured to lock the lifting tool to the second posture with respect to the shaft.SELECTED DRAWING: Figure 3

Description

Technical Field

[0001] The present invention broadly relates to an endoscope having a multi-angular viewing direction and an adjustable elevator for providing a multi-angular operating direction.

Background Art

[0002] Endoscopic retrograde cholangiopancreatography (ERC) is a procedure used to diagnose and treat patients with pancreaticobiliary diseases. ERCP is usually performed using a side-viewing endoscope having an elevating mechanism. By arranging the side-viewing endoscope and the elevating mechanism, a physician can insert a cannula into the duodenal papilla and reach the target site with instruments for diagnostic and therapeutic ERCP procedures.

[0003] In some patients with altered anatomical structures, a forward-viewing endoscope may sometimes be used. However, such an endoscope lacks the function of an elevator or a side-viewing image sensor, so the diagnostic and treatment capabilities of the physician may be limited compared to using a side-viewing endoscope having an elevator and a side-viewing image sensor. Also, currently commercially available forward-viewing endoscopes may be longer than side-viewing endoscopes and may require the use of different cannulation methods and different instruments. In certain patients with altered anatomical structures, commercially available forward-viewing endoscopes may work well, but using them may require changes in the procedure by the physician and additional effort compared to performing ERCP using a side-viewing endoscope.

Summary of the Invention

[0004] Examples of the present invention relate in particular to an endoscope having a multi-angular viewing direction and an adjustable elevator (e.g., a tubular member) for providing a multi-angular operating direction. Each of the examples disclosed herein may include one or more of the features described in relation to any of the other disclosed examples.

[0005] In one example, the endoscope may comprise a shaft having a longitudinal axis, a first image sensor oriented in the distal direction, and a second image sensor oriented in the lateral direction. The endoscope may further comprise a tubular member having a lumen, the lumen having a distal end opening and defining a longitudinal axis passing through the center of the lumen. The tubular member may be translatable between a first posture and a second posture. In the first posture of the tubular member, the longitudinal axis of the lumen may be parallel to the longitudinal axis of the shaft. In the second posture of the tubular member, the longitudinal axis of the lumen may extend through a lateral opening in the wall of the shaft.

[0006] Any of the examples of endoscopes described in this specification may further include one or more of the following features. The first image sensor may be disposed on a wall facing the distal direction of the shaft, and the second image sensor may be disposed on a wall facing the lateral direction of the shaft. In the first posture, the distal end opening may be parallel to the wall facing the distal direction of the shaft. The wall facing the distal direction may be disposed at the most distal end of the shaft. The first image sensor may be adjustable relative to the wall facing the distal direction, and the second image sensor may be adjustable relative to the wall facing the lateral direction. The wall facing the lateral direction of the shaft may be flat, and the wall facing the distal direction and the wall facing the lateral direction may be perpendicular to each other. The distal direction and the lateral direction may be approximately 90° to each other. The endoscope may further include a medical device disposed within a tubular member. In the first posture, the medical device may extend from the distal end opening of the tubular member, and the first image sensor may be configured to image the medical device. In the second posture, the medical device may extend from the distal end opening of the tubular member, and the second image sensor may be configured to image the medical device. The tubular member is further movable to a third posture, and in the third posture, the medical device may be locked to the wall of the shaft. The endoscope may further include a first light source associated with the first image sensor and a second light source associated with the second image sensor. The endoscope may further include a plurality of light sources. The wall of the shaft may include a recess opening in the distal direction configured to receive and fix the medical device to the wall of the shaft. In the first posture of the tubular member, the longitudinal axis of the lumen may extend through the distal opening of the wall of the shaft. The movement range of the tubular member may be at least 80°. Alternatively, the tubular member may translate axially relative to the shaft.

[0007] In other examples, the endoscope may include a first image sensor, a second image sensor, and a tube-shaped member. The first image sensor is disposed on a wall facing the distal direction of the shaft. The second image sensor is disposed on a wall facing the lateral direction of the shaft. The tube-shaped member has a lumen, and the lumen has a distal end opening and defines a longitudinal axis passing through the center of the lumen. The tube-shaped member may be movable between a first posture and a second posture. In the first posture of the tube-shaped member, the distal end opening may be parallel to the wall facing the distal direction of the shaft. In the second posture of the tube-shaped member, the longitudinal axis of the lumen may extend through the lateral opening of the shaft.

[0008] Any of the examples of endoscopes described herein may further include one or more of the following features. The first image sensor can face in a first direction, the second image sensor can face in a second direction, and the first direction and the second direction can be approximately 90° to each other. The endoscope may further include a first light source associated with the first image sensor and a second light source associated with the second image sensor. The wall facing the lateral direction of the shaft may be flat and the wall facing the distal direction and the wall facing the lateral direction may be perpendicular to each other. The tube-shaped member may be further movable to a third posture, in which a medical device disposed within the lumen can be locked with respect to the shaft. The tube-shaped member may be translatable with respect to the wall facing the distal direction and the wall facing the lateral direction. That is, in the first posture of the tube-shaped member, the longitudinal axis of the lumen may be parallel to the longitudinal axis of the shaft.

[0009] In yet other examples, a method of imaging a patient using an endoscope can include using a first image sensor oriented in a distal direction to image a first portion of the patient, and a tubular member having a lumen that has a distal end opening and defines a longitudinal axis passing through the center of the lumen, transitioning the tubular member from a first posture to a second posture, and using a second image sensor oriented in a lateral direction to image a second portion of the patient. In the first posture of the tubular member, the longitudinal axis of the lumen can be parallel to the longitudinal axis of the shaft of the endoscope, while in the second posture of the tubular member, the longitudinal axis of the lumen can extend through the lateral opening of the shaft.

[0010] Any of the methods described herein can further include one or more of the following features or steps. The method can further include disposing a medical device within the lumen of the tubular member. The method can further include transitioning the tubular member from the second posture to a third posture, wherein transitioning the tubular member from the second posture to the third posture locks the medical device relative to the shaft. In the first posture, the distal end opening of the lumen can be parallel to the distal end wall of the shaft. That is, the step of using the second image sensor to image the second portion of the patient can be performed when the tubular member is in the second posture.

[0011] It will be understood that the above summary and the following detailed description are merely exemplary and explanatory and are not restrictive of the invention claimed. As used herein, the expressions “comprising,” “comprises,” or any other variation thereof, are intended to cover a non-exclusive inclusion, such that a process, method, article, or apparatus that comprises a list of elements does not include only those elements but may include other elements not expressly listed or inherent to such process, method, article, or apparatus. The expression “exemplary” is used in the sense of “example” rather than “ideal.”

[0012] The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate examples of the invention and, together with the description, serve to explain the principles of the invention.

Brief Description of the Drawings

[0013]

Figure 1

Figure 2

Figure 3

Figure 4

Figure 5

Modes for Carrying Out the Invention

[0014] The present invention relates to an endoscope having a multi-angular viewing direction. In order to achieve imaging in multi-angular directions, the endoscope may have two or more image sensors. Further, the endoscope may have a lifting device (e.g., a tubular member) with an adjustable distal portion that enables the endoscope to have both a front exit working channel and a lateral exit working channel.

[0015] Referring to FIG. 1, the endoscope 2 may include an elongated flexible tube-shaped shaft having a distal tip 4. The distal tip 4 may bend left and right, and up and down, relative to the proximal portion of the tube-shaped shaft. The endoscope 2 may further include a lifter that defines a lumen 8, i.e., a tube-shaped member 6, a forward viewing system 12, and a lateral viewing system 14. The tube-shaped shaft (or the distal tip 4) of the endoscope 2 may define a longitudinal axis A that extends in the proximal-distal direction through the center of the distal tip 4. In other examples, the longitudinal axis A may extend in the proximal-distal direction through the distal tip 4, but may be eccentric. The forward viewing system 12 may include an image sensor 16, a light source 18, and a lens wash 20. Similarly, the lateral viewing system 14 may include an image sensor 22, a light source 24, and a lens wash 26. The endoscope 2 may be any device used to visually examine a patient's anatomical structure and may be used for any suitable procedure. For example, the endoscope 2 may be used to examine a patient's gastrointestinal, vascular, respiratory, or urinary system.

[0016] The tube-shaped member 6 may include an elongated tube extending from the proximal end to the distal end of the endoscope 2. The tube-shaped member 6 may include any suitable biocompatible material, such as a polymer, urethane, fluoropolymer blend, or metal (e.g., stainless steel). The tube-shaped member 6 may include a distal portion 28 shown that is bendable relative to the proximal portion (not shown) of the tube-shaped member 6. To facilitate bending in a desired region between the proximal portion and the distal portion 28 of the tube-shaped member 6, the tube-shaped member 6 may include a coiled tube portion, a laser cut pattern that forms an easily bendable weakened region, a hinge, or any other suitable mechanism that allows two portions to bend relative to each other.

[0017] The tubular member 6 may have or define a lumen 8. In one example, the lumen 8 may have a circular cross-section. In other examples, the cross-section of the lumen 8 may be elliptical, polygonal, irregular, or any other suitable shape. The lumen 8 may include a distal opening 30 at the distal end of the distal portion 28. The lumen 8 (or the distal portion 28 of the tubular member 6) may define a longitudinal axis B that extends from a proximal end (e.g., adjacent to the bendable region of the tubular member 6) through the center of the distal portion 28 to the distal opening 30. In other examples, although the longitudinal axis B may extend in the proximal-distal direction through the distal portion 28, it may be eccentric. The opening 30 may provide an exit for a medical device 32, such as a guidewire or other therapeutic or diagnostic device. To place the medical device 32 within the lumen 8, as shown in FIG. 1, the distal end of the medical device 32 may be inserted into the proximal end of the tubular member 6 and extended through the lumen 8 and out of the distal opening 30.

[0018] The distal portion 28 of the tubular member 6 may be movable between a first posture shown in FIG. 1 and a second posture shown in FIG. 2. FIG. 3 shows the tubular member in a third posture. It should be understood that the distal portion 28 is further movable between the first and third postures and between the second and third postures. In the first posture of FIG. 1, the distal opening 30 may be parallel to the distal end wall 34 of the distal tip 4. Further, the longitudinal axis B of the lumen 8 may be parallel to the longitudinal axis A of the tubular shaft (or the distal tip 4) of the endoscope 2. Thus, in the first posture, the tubular member 6 may define a working channel (lumen 8) of the endoscope 2 having a front exit. The front exit may be near the distal end wall 34 or in the same plane as the distal end wall 34. When the tubular member 6 is in the first posture, the forward viewing system 12 may be used to visualize an instrument such as the medical device 32 extending from the tubular member 6.

[0019] When the tubular member 6 is in the second posture shown in FIG. 2, the distal opening 30 can form an angle with the distal end wall 34 of the distal tip 4. Similarly, the longitudinal axis B of the distal portion 28 of the tubular member 6 can form an angle Θ with the longitudinal axis A of the tubular shaft (or the distal tip 4) of the endoscope 2. Thus, in the second posture, the tubular member 6 can define the working channel (lumen 8) of the endoscope 2 having a lateral or transverse outlet. When the tubular member 6 is in the second posture, a lateral view system 14 can be used to visualize an instrument such as a medical device 32 extending from the tubular member 6.

[0020] FIG. 3 shows the tubular member 6 in a third posture, sometimes referred to as the locked posture. In the third posture, the movement of the medical device 32 relative to the tubular member 6 can be restricted or blocked. In one example, the third posture can be the position of the tubular member 6 when the distal portion 28 of the tubular member 6 (along with the medical device 32 extending from the distal opening 30) is in a position maximally bent with respect to the longitudinal axis of the distal tip 4 of the endoscope 2. That is, in the third posture, the angle Θ can be an angle greater than the angle Θ when the tubular member 6 is in the first or second posture. The distal tip 4 can include a notch, i.e., a recess 36, sized to receive and fix the medical device 32 relative to the distal tip 4 of the tubular shaft. The recess 36 can open distally. When the tubular member 6 transitions to the third posture, the medical device 32 can be clamped between the wall of the distal portion 28 and the recess 36 and can form an interference fit with the distal tip 4 through the recess 36. In the third posture of the tubular member 6, as will be described further below, the medical device 32 can be fixedly held when a catheter or other medical device is advanced along the medical device 32 within the lumen 8. However, advancing a medical tool covering the device 32 can also be done when in any of the first, second, or third postures.

[0021] Referring to FIGS. 3, 4, and 5, the wall of the distal tip 4 of the tubular shaft of the endoscope 2 may include a lateral opening 38 for allowing an instrument extending from the distal end opening 30 of the tubular member 6 to follow outside the endoscope 2, and a distal opening 40 (of the distal end wall 34). The opening 38 and the opening 40 are connected so as to form a single opening facing both in the distal direction and the lateral direction at the distal tip 4. The lateral opening 38 may extend in the proximal direction from the distal end wall 34. From the distal end wall 34, the first side surface 37 and the second side surface 39 of the lateral opening 38 may extend parallel to each other over a part of the length (in the proximal-distal direction) of the lateral opening 38. In the proximal direction therefrom, the two side surfaces 37, 39 may transition so as to approach each other and towards the recess 36. The recess 36 may be part of the lateral opening 38 and may be defined proximally by a curved portion of the wall of the distal tip 4 extending between the first side surface 37 and the second side surface 39.

[0022] The distal opening 40 may be the distal end of a lumen 44 that penetrates and extends longitudinally through the distal tip 4 of the tubular shaft of the endoscope 2. Referring to FIG. 4, the distal opening 40 may extend from the upper edge of the distal tip 4 and is continuous from the upper edge of the distal tip 4 to the lateral opening 38. From this lateral opening 38, the distal opening 40 may extend towards the opposing wall of the distal tip 4 (towards the lower side of the paper when viewing FIG. 4). The distal opening 40 may curve at its bottom edge such that the wall of the distal end wall 34 around the distal opening 40 forms a U-shape (as viewed in FIG. 4). Due to the U-shape of the distal opening 40, the distal portion 28 of the tubular member 6 may be able to extend in the completely straight first posture shown in FIGS. 1 and 4. In one example, the curvature at the bottom of the distal opening 40 may match the curvature of the outer surface of the tubular member 6.

[0023] When transitioning the tubular member 6 from the first posture to the second or third posture, the medical device 32 may have a continuous passageway to the outside of the endoscope 2 via the distal opening 40 and the lateral opening 38. For example, in the first posture shown in FIG. 1, the medical device 32 may reach the outside of the endoscope 2 through the distal opening 40. As the tubular member 6 approaches the second posture shown in FIG. 2, the medical device 32 may pass through the lateral opening 38 so as to extend from the lumen 8 to the outside of the endoscope 2. Accordingly, the distal opening 40 and the lateral opening 38 provide a path such that an instrument extending from the distal end opening 30 of the lumen 8 can reach the outside of the endoscope 2. In other words, when the tubular member 6 is in the first posture, the longitudinal axis B of the tubular member 6 may extend through the distal opening 40. On the other hand, in the second posture of the tubular member 6, the longitudinal axis B may extend through the lateral opening 38. In the third posture of the tubular member 6, when the longitudinal axis B passes through the center of the lumen 8 (as shown in FIG. 3, for example), the longitudinal axis B may extend through the wall of the distal tip 4. On the other hand, when the longitudinal axis B is eccentric, when the tubular member 6 is in the third posture, the longitudinal axis B may still extend through the lateral opening 38.

[0024] The tubular member 6 can be moved by some mechanism well-known in the art over its area of movement (e.g., between a first posture, a second posture, and a third posture). In one example, a wire (not shown) can be secured outside the distal portion 28 (e.g., by a ring around the tubular member 6, by an adhesive, by soldering, etc.), and it can be passed in a proximal direction towards the proximal end of the tubular member 6. The user can pull the wire in the proximal direction to move the distal portion 28 from the first posture towards the second posture or the third posture. That is, the proximal movement of the wire can increase the flexion of the distal portion 28 with respect to the distal tip 4 of the endoscope 2 (e.g., can increase the angle Θ). For convenience, the flexion movement of the distal portion 28 that increases the angle Θ is referred to herein as the "proximal direction" movement of the distal portion 28. Conversely, the user can push the wire or other mechanism in the distal direction to move the distal portion 28 from the second posture or the third posture towards the first posture. That is, the distal movement of the wire can decrease the flexion of the distal portion 28 with respect to the distal tip 4 of the endoscope 2 (e.g., can decrease the angle Θ), and can move towards a position where the longitudinal axis B is parallel to the longitudinal axis A. For convenience, this straightening movement of the distal portion 28 that decreases the angle Θ is referred to herein as the "distal direction" movement of the distal portion 28.

[0025] In one example, the distal portion 28 of the tubular member 6 can have a region of motion of about 85°. As used herein, "about" means including ±5%. According to this example, the region of motion can be defined as the angle Θ between a first posture and a second posture (e.g., between FIG. 1 and FIG. 2), or the angle Θ between a first posture and a third posture (e.g., between FIG. 1 and FIG. 3). When the region of motion is the angle Θ between the first posture and the second posture, the region of motion can include any position of the distal portion 28 where the medical device 32 can move freely while protruding from the distal end opening 30 of the distal portion 28. When the region of motion is the angle Θ between the first posture and the third posture, the region of motion can include any position of the distal portion 28 where the medical device 32 can protrude from the distal end opening of the distal portion 28, whether the medical device 32 can move freely or is locked.

[0026] In other examples, the distal portion 28 can have a region of motion of about 70°, about 75°, about 80°, or about 90°. In still other examples, the region of motion of the distal portion 28 can be at least 80°, at least 85°, at least 90°, at least 95°, less than 95°, less than 90°, less than 85°, or less than 80°. To increase the region of motion beyond that shown, the lateral opening 38 of the distal tip 4 can be extended proximally so that the distal portion 28 and the medical device 32 within its lumen can be further bent proximally. Alternatively, the tubular member 6 can translate, i.e., slide, distally within the lumen 44 of the tubular shaft so that the distal portion 28 can have a sufficient region of desired motion. To decrease the region of motion, the lateral opening 38 of the distal tip 4 can be shortened (e.g., the recess 36 can be moved distally) so that the distal portion 28 and the medical device 32 within the lumen are not bent as much proximally. Alternatively, the tubular member 6 can translate, i.e., slide, proximally within the lumen 44 of the tubular shaft to sufficiently decrease the region of motion of the distal portion 28.

[0027] FIG. 4 shows a distal end view of the endoscope 2 showing the forward view system 12, and FIG. 5 shows a top view of the distal tip 4 showing the lateral view system 14. The image sensors 16, 22 can be any sensors such as CMOS sensors or CCD sensors that detect light and transmit information to enable remote viewing of images. The light sources 18, 24 can emit any kind of light for irradiating the vicinity of the associated image sensors 16, 22. The lens washes 20, 26 can provide outlets for water, saline, or other fluids used to wash the corresponding image sensors 16, 22 and / or light sources 18, 24. The lens wash 20 can include an outlet nozzle 20a for discharging fluid from the lens wash 20. Similarly, the lens wash 26 can include an outlet nozzle 26a for discharging fluid from the lens wash 26.

[0028] Referring to the distal end view of FIG. 4, the components of the forward view system 12 can be disposed on the distal tip 4 / tubular shaft / distal end wall 34 of the endoscope 2. The distal end wall 34 can be perpendicular to the longitudinal axis A. The image sensor 16 can be disposed on the left side of the distal opening 40. The light source 18 can be disposed (as seen in FIG. 4) below the image sensor 16 and can be associated with the image sensor 16 by being disposed to irradiate the vicinity of the image sensor 16. The lens wash 20 can be disposed (as seen in FIG. 4) above the image sensor 16 and can be configured to discharge fluid to clean the image sensor 16 and / or the light source 18. However, the image sensor 16, the light source 18, and the lens wash 20 can be arranged in any other order or configuration relative to each other. For example, two or more of these components can be arranged adjacent to each other (side by side as seen in FIG. 4). Alternatively, one or more of the image sensor 16, the light source 18, and the lens wash 20 can be arranged on the opposite side of the distal opening 40 (e.g., on the portion of the distal end wall 34 closer to the lateral view system 14 and to the right of the distal opening 40 as seen in FIG. 4). In another example, one or more of the image sensor 16, the light source 18, and the lens wash 20 can be arranged on the wall of the tubular shaft of the endoscope 2 facing distally that is not the most distal end of the endoscope 2 (e.g., on the distal wall 46 (see FIG. 1) or other wall facing distally).

[0029] Referring to the top view of FIG. 5, the image sensor 22 can be disposed in the vicinity (and proximal side) of the distal end wall 34, and the light source 24 can be disposed on the proximal side of the image sensor 22. The image sensor 22 and the light source 24 can be disposed on the transverse wall 42 of the distal tip 4 / tubular shaft / endoscope 2. The light source 24 can be associated with the image sensor 22 by being disposed to irradiate the vicinity area of the image sensor 22. The transverse wall 42 can be any wall facing in the transverse direction, and can be curved or flat. Referring to FIGS. 1-3, in one example, the transverse wall 42 can be a flat wall extending in the proximal direction from the distal end wall 34. In other examples, the transverse wall 42 can be the curved outer surface of the distal tip 4. Referring again to FIG. 5, the lens wash 26 can be disposed on the distal wall 46 on the proximal side of the light source 24. The lens wash 26 can include an outlet, through which saline or other fluid can pass and be discharged along the transverse wall 42 to wash the image sensor 22 and / or the light source 24. The image sensor 22, the light source 24, and the lens wash 26 can be arranged in any other order or configuration relative to each other. Alternatively, one or more of these components can be disposed on the opposite side of the transverse opening 38 (e.g., on the left side of the transverse opening 38 as viewed in FIG. 5).

[0030] The image sensor 16 on the distal end wall 34 can face distally. Thus, the image sensor 16 can be used to observe the medical device 32 and any other instrument extending from the distal end opening 30 when the tubular member 28 is in the first posture and when it is transitioning proximally toward the second posture. On the other hand, the image sensor 22 on the transverse wall 42 can face transversely. Thus, the image sensor 22 can be used to observe the medical device 32 and any other instrument extending from the distal end opening 30 when the tubular member 28 is approaching the second posture or when it is in the second or third postures.

[0031] In one example, the distal end wall 34 (or any other wall facing distally, including the image sensor 16) and the transverse wall 42 (or any other wall facing transversely, including the image sensor 22) can be perpendicular to each other. The angle described herein between these two walls can correspond to the angle between the viewing directions of the image sensors 16, 22. In other examples, the distal end wall 34 and the transverse wall 42 (and the viewing directions of the corresponding image sensors 16, 22) can deviate from 90°, but can be arranged approximately 90° to each other. In other examples, the two walls can be arranged approximately 85°, approximately 80°, or approximately 75° to each other. In still other examples, the two walls can be arranged at least 90° or less than 90° to each other.

[0032] In one example, it is possible to adjust the viewing directions of the image sensors 16, 22 relative to their corresponding walls. For example, the viewing direction of the image sensor 16 can be adjusted to swing along one or more axes within the range of the distal end wall 34 relative to its default position, and the default position is a position facing in the same direction as the distal end wall 34. Similarly, the viewing direction of the image sensor 22 can be adjusted to swing along one or more axes within the range of the transverse wall 42 relative to its default position, and the default position is a position facing in the same direction as the transverse wall 42.

[0033] In an exemplary procedure using the endoscope 2, in the first step of the procedure, the distal tip 4 can be inserted through the patient's mouth, esophagus, stomach, and duodenum. In the first step of the procedure, the forward viewing system 12 can be used to assist the user in navigating through the patient's anatomical structure. When navigating to the duodenum, the tubular member 6 can be placed in a first posture to allow a medical device 32 (such as a guidewire) or other instrument to move distally beyond the distal end wall 34 of the distal tip 4. For example, a guidewire can be inserted from the stomach through the pylorus to assist in navigating the distal tip 4 from the stomach to the duodenum.

[0034] In the vicinity of the duodenal papilla, to assist in confirming the position of the duodenal papilla, the user may use the lateral view system 14. Using the guidance from the lateral view system 14, a medical device 32 (e.g., a guide wire) can be inserted into the pancreatic duct of the patient via the duodenal papilla. To assist in inserting the medical device 32 into the duodenal papilla, the tubular member 6 can be shifted to a second posture so that the medical device 32 can extend from the lateral side of the endoscope 2. When the medical device 32 extends from the lateral side of the distal tip 4, the endoscope 2 and its distal tip 4 can be maintained in a substantially straight posture within the duodenum. Once the medical device 32 is inserted into the pancreatic duct, the tubular member 6 can be shifted to a third posture to lock the medical device 32 relative to the distal tip 4 of the tubular shaft. In one example, both view systems 12, 14 can be used simultaneously at any part of the procedure.

[0035] Next, a cannula (not shown) can be placed over the medical device 32 and inserted through the lumen 8 of the tubular member 6. Once the cannula reaches the distal tip 4, the tubular member 6 can be shifted proximally to the second posture (or beyond the second posture towards the first posture) to unlock the medical device 32. Next, for cannulation of the pancreatic duct, the cannula can be extended along the medical device 32 from the distal end opening 30 and passed into the pancreatic duct. It is possible to inject a contrast agent into the pancreatic duct, and an X-ray fluoroscopic image can be acquired to examine the bile duct, gallbladder, and pancreatic duct. If necessary, other instruments can be inserted into the pancreatic duct through the tubular member 6 and / or the cannula to treat symptoms of the pancreas or bile duct.

[0036] (Appendix) As a preferred embodiment, the technical idea understood from the above embodiment is described below. [Item 1] A medical device, The medical device includes a shaft having a distal end, and the shaft has a first opening facing in a first direction, and a second opening facing in a second direction different from the first opening including the medical device comprises a lifting device disposed within the shaft the lifting device is configured such that, in a non-operating position, a medical instrument can move outward from the shaft along the first direction through the first opening, and the lifting device is configured such that, in an operating position, the medical instrument can be actuated and the medical instrument can extend outward from the shaft along the second direction through the second opening the lifting device is fixed in the operating position, thereby maintaining the medical instrument in the operating position in response to the shaft with which at least a part of the medical instrument engages at the distal end, a medical device [Item 2] the shaft includes a third opening at the distal end, the third opening facing the first direction and the second direction, the medical device according to Item 1 [Item 3] the third opening is formed in a size and shape to receive at least a part of the medical instrument, the medical device according to Item 2 [Item 4] the shaft is configured to fix the lifting device to the distal end in response to at least a part of the medical instrument being received in the third opening, the medical device according to Item 3 [Item 5] the third opening is a recess in the wall of the shaft at the distal end, the medical device according to Item 2 [Item 6] the recess forms an interference fit with at least a part of the medical instrument, thereby configuring the lifting device to lock with respect to the shaft, the medical device according to Item 5 [Item 7] the third opening is configured to restrict the lifting device from moving from the operating position to the non-operating position when at least a part of the medical instrument is received within the third opening, the medical device according to Item 2 [Item 8] The shaft includes a first wall and a second wall at the distal end that at least partially defines the second opening. The first wall and the second wall are aligned with each other, and the third opening is located between the first wall and the second wall. The medical device according to item 2. [Item 9] The first wall and the second wall are configured to guide the medical instrument toward the third opening when the lifter moves from the non-operating position to the operating position to operate the medical instrument. The medical device according to item 8. [Item 10] The third opening is located along the proximal side of the shaft with respect to the first opening and the second opening. The medical device according to item 3. [Item 11] The medical instrument is configured to move beyond the lifter when the lifter is in the non-operating position. The medical device according to item 1. [Item 12] The shaft A first sensor that is close to the first opening and faces the first direction, A second sensor that is close to the second opening and faces the second direction and includes When the lifter is in the non-operating position, the medical instrument is at least partially reflected in the first sensor and not in the second sensor. When the lifter is in the operating position, the medical instrument is at least partially reflected in the second sensor and not in the first sensor. The medical device according to item 1. [Item 13] The first sensor includes an imaging element, and the first sensor is configured to image the medical instrument when the lifter is in the non-operating position. The medical device according to item 12. [Item 14] The second sensor includes an imaging element, and the second sensor is configured to image the medical instrument when the lifter is in the operating position. The medical device according to item 12. [Item 15] A medical device The medical device includes a shaft having a distal end defined by a first surface and a second surface different from the first surface, the first surface including a first opening, and the second surface including a second opening facing in a different direction from the first opening. The medical device includes a lifter located within the shaft and movable relative to the first and second surfaces, the lifter being configured to move between a non-operative position and an operative position when moving a medical instrument received by the lifter from a non-operative position to an operative position. In the non-operative position, the lifter is configured to be able to move the medical instrument out of the shaft through the first opening, and in the operative position, the lifter is configured such that the medical instrument can be actuated and the medical instrument can extend out of the shaft through the second opening. The medical instrument is press-fitted and retained in a portion facing in the distal direction of the second surface when the lifter moves from the non-operative position to the operative position, thereby fixing the medical instrument to the distal end and maintaining the lifter in the operative position. A medical device. [Item 16] The shaft includes a first sensor located on a first wall of the shaft, the first wall defining the first surface. The shaft includes a second sensor located on a second wall of the shaft different from the first wall, the second wall defining a third surface different from the first and second surfaces. The medical device according to item 15, wherein the lifter is configured to position the medical instrument such that in the non-operative position, the medical instrument at least partially appears in the first sensor and does not appear in the second sensor, and in the operative position, the medical instrument at least partially appears in the second sensor and does not appear in the first sensor. [Item 17] The portion of the second surface facing in the distal direction includes a third opening, the third opening is disposed adjacent to the second opening, and the third opening is configured to fix the medical instrument to the distal end in response to the lifter moved to the operating position, the medical device according to item 15. [Item 18] The third opening is configured to restrict movement of the lifter from the operating position to the non-operating position when the medical instrument is received within the third opening, the medical device according to item 17. [Item 19] The lifter is configured to slidably receive the medical instrument in the non-operating position and the operating position, the medical device according to item 17. In this specification, although the principles of the present invention have been described with reference to specific application examples, it should be understood that the present invention is not limited to those examples. Those skilled in the art who have obtained the teachings presented in this specification will be able to recognize further variations, applications, and substitutions by equivalents that are within the scope of the examples described herein. Therefore, the present invention should not be regarded as limited by the above description.

Claims

**Claim 1** A medical device, the medical device comprising a shaft having a longitudinal axis, the medical device comprising an image sensor, the medical device comprising a lifter having a lumen that defines a longitudinal axis passing through the center of the lumen and having a distal end opening, the lifter being movable between a first position and a second position, in the first position of the lifter, the distal end opening is positioned to allow an instrument to extend from the front opening of the shaft, in the second position of the lifter, the distal end opening is positioned to allow an instrument to extend from the side opening of the shaft, and a portion of the shaft is positioned to cover and block at least a portion of the distal end opening of the lifter when the lifter is in the second position. A medical device. **Claim 2** The medical device according to claim 1, wherein in the first position of the lifter, the longitudinal axis of the lumen is generally parallel to the longitudinal axis of the shaft. **Claim 3** The medical device according to claim 1, wherein the image sensor is provided on the wall of the shaft. **Claim 4** The medical device according to claim 1, wherein the image sensor comprises a first image sensor facing a first direction and a second image sensor facing a second direction. **Claim 5** The medical device according to claim 4, wherein the first image sensor is disposed on a wall facing the distal direction of the shaft, and the second image sensor is disposed on a wall facing the lateral direction of the shaft. **Claim 6** The medical device according to claim 5, wherein in the first position of the lifter, the distal end opening is generally parallel to the wall facing the distal direction of the shaft, and the lifter is configured to move distally of the wall facing the distal direction of the shaft. **Claim 7** The medical device according to claim 1, further comprising the instrument disposed within the lifter, and in the first position of the lifter, the instrument is configured to move distally through the front opening of the shaft. **Claim 8** The medical device according to claim 7, wherein the shaft has a recess sized and shaped to receive a portion of the instrument. **Claim 9** The medical device according to claim 8, wherein the recess forms an interference fit with a portion of the instrument, thereby configuring the lifter to lock in the second position with respect to the shaft. **Claim 10** The shaft includes a first wall and a second wall that at least partially defines the lateral opening, and the recess is disposed between the first wall and the second wall. The medical device according to claim 8.

11. The first wall and the second wall of the shaft are configured to guide the instrument into the recess in response to the lifter shifting from the first posture to the second posture. The medical device according to claim 10.

12. The medical device according to claim 1 further comprises an actuating mechanism configured to shift the lifter relative to the shaft between the first posture and the second posture.

13. A medical device, the medical device includes a shaft having a longitudinal axis, the medical device includes an image sensor, the medical device includes a lifter disposed within the shaft, the lifter includes a lumen that has a distal end opening and defines a longitudinal axis passing through the center of the lumen, the medical device includes an actuating mechanism configured to shift the lifter relative to the shaft between a first posture and a second posture, In the second posture of the lifter, a portion of the shaft is positioned to cover and block at least a portion of the distal end opening of the lifter. A medical device.

14. The medical device further comprises an instrument disposed within the lumen of the lifter, In the first posture, the distal end opening is positioned to allow the instrument to extend from the front opening of the shaft, In the second posture of the lifter, the distal end opening is positioned to allow the instrument to extend from the lateral opening of the shaft. The medical device according to claim 13.

15. The shaft includes a recess sized and shaped to receive a portion of the instrument. The medical device according to claim 14.

16. The recess forms an interference fit with a portion of the instrument and is configured to lock the lifter in the second posture relative to the shaft. The medical device according to claim 15.

17. The image sensor includes a first image sensor facing a first direction and a second image sensor facing a second direction. The medical device according to claim 13.

18. The medical device according to claim 17, wherein the first image sensor is disposed on a wall facing the distal direction of the shaft, and the second image sensor is disposed on a wall facing the lateral direction of the shaft.

19. In the first posture, the distal end opening is substantially parallel to a wall facing the distal direction of the shaft, and the elevator is configured to move distally of a wall facing the distal direction of the shaft. The medical device according to claim 18.

20. A medical device, the medical device comprising a shaft having a longitudinal axis, the medical device comprising an image sensor, the medical device comprising an elevator disposed within the shaft, the elevator comprising a lumen that has a distal end opening and defines a longitudinal axis passing through the center of the lumen, the medical device comprising an actuating mechanism configured to shift the elevator relative to the shaft between a first posture and a second posture, the medical device comprising an instrument disposed within the lumen of the elevator, in the first posture of the elevator, the distal end opening is positioned to permit the instrument to extend from a front opening of the shaft and not to extend from a lateral opening of the shaft, in the second posture of the elevator, the distal end opening is positioned to permit the instrument to extend from the lateral opening of the shaft and not to extend from the front opening of the shaft, and a portion of the shaft is positioned to cover and block at least a portion of the distal end opening of the elevator, the shaft comprising a recess sized and shaped to receive a portion of the instrument, the recess configured to form an interference fit with a portion of the instrument, thereby locking the elevator in the second posture relative to the shaft. A medical device.

Images