Medical devices, including medical device management systems

Abstract

To provide an actuation mechanism, an endoscopic medical device, and an actuation assembly for an endoscope that allows a physician to operate the tip of an elongated shaft of the endoscope with one hand and also allows additional devices to be operated with the same hand. An actuation mechanism for an endoscope is disclosed. The actuation mechanism includes a housing configured to be attached to a handle of the endoscope and a thumb wheel coupled to the housing. Rotation of the thumb wheel causes longitudinal movement of an elongated medical device through a working channel of the endoscope. In some cases, the actuation mechanism includes a drive wheel and / or a roller wheel, and the elongated medical device is compressively positioned between the roller wheel and / or the drive wheel. Rotation of the thumb wheel can rotate the drive wheel and / or the roller wheel in an opposite rotational direction.

Description

[Technical Field]

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS This application claims the benefit of and priority to U.S. Provisional Patent Application No. 63 / 155,955, filed March 3, 2021, the disclosure of which is incorporated herein by reference.

[0002] The present disclosure relates to medical devices and methods of manufacturing medical devices. More particularly, the present disclosure relates to medical devices including an ergonomic medical device management system for elongated devices used in conjunction with the medical device. [Background technology]

[0003] Flexible ureteroscopes are utilized in the examination and treatment of the kidney and may generally include features that improve treatment site accessibility and patient comfort. Flexible ureteroscopes may be provided with a flexible tip section that is controlled by the physician through manipulation of various components attached to the handle of the scope. Such manipulation allows the physician to guide the tip of the scope to various locations within the body (e.g., various locations within the kidney). Furthermore, ureteroscopes are typically used in conjunction with other medical devices during medical procedures. For example, urologists may use flexible ureteroscopes in combination with both a laser fiber and a retrieval device (e.g., a retrieval basket) to break up kidney stones and remove the fragments from the body. Thus, these procedures may require not only manipulation of various features of the ureteroscope to control the tip of the scope, but also the introduction and manipulation of auxiliary devices used in conjunction with the ureteroscope.

[0004] Operating both a ureteroscope and an auxiliary device requires an assistant to exchange one or more elongated devices while the physician operates the ureteroscope handle. This exchange can be time-consuming and may result in accidental dropping or damage to the elongated device, adding additional time and cost to the procedure. Therefore, it would be desirable to design a handle for a ureteroscope or other endoscopic device that allows a physician to operate the tip of the elongated shaft of the endoscope with one hand while also allowing the physician to operate additional devices with the same hand. Disclosed herein is a medical device that includes a handle with a device management system that allows a user to operate the handle along with additional auxiliary devices. [Prior art documents] [Patent documents]

[0005] [Patent Document 1] U.S. Patent No. 5,238,004 [Patent Document 2] U.S. Patent No. 6,508,803 Summary of the Invention [Problem to be solved by the invention]

[0006] This disclosure provides design, materials, manufacturing methods, and use alternatives for medical devices. [Means for solving the problem]

[0007] One example is an actuation mechanism for an endoscope, the actuation mechanism including a housing configured to attach to a handle of the endoscope and a first thumb wheel coupled to the housing, wherein rotation of the first thumb wheel causes longitudinal movement of a first elongated medical device through a working channel of the endoscope.

[0008] Alternatively or additionally to any of the above embodiments, the actuation mechanism further includes a first drive wheel coupled to the housing, the first thumb wheel engaging the first drive wheel such that rotation of the first thumb wheel causes rotation of the first drive wheel.

[0009] Alternatively or additionally to any of the above embodiments, the actuation mechanism further includes a first roller wheel coupled to the housing. The outer circumferential surface of the first roller wheel is positioned adjacent to the outer circumferential surface of the first drive wheel such that the first elongated medical device can be positioned between the outer circumferential surface of the first roller wheel and the outer circumferential surface of the first drive wheel. Rotation of the first thumb wheel causes rotation of the first drive wheel to move the first elongated medical device through the working channel of the endoscope.

[0010] Alternatively or additionally to any of the above embodiments, the first roller wheel and the first drive wheel are configured to cooperatively exert a compressive force on the first elongated medical device to frictionally engage the first elongated medical device therebetween.

[0011] Alternatively or additionally, the first thumb wheel includes a circumferential surface, and a band of material extends around each of the first thumb wheel, the first drive wheel, and the first roller wheel.

[0012] Alternatively or additionally, the housing includes an inner housing and an outer housing, and the first thumb wheel, the first drive wheel, and the first roller wheel are positioned between the inner housing and the outer housing.

[0013] Alternatively or additionally to any of the above embodiments, the actuation mechanism further includes a second thumb wheel coupled to the housing, a second drive wheel coupled to the housing, and a second roller wheel coupled to the housing, wherein the second thumb wheel engages the second drive wheel such that rotation of the second thumb wheel causes longitudinal movement of the second elongated medical device through the working channel of the endoscope.

[0014] Alternatively or additionally to any of the above embodiments, the first thumb wheel includes a first diameter and the first drive wheel includes a second diameter, the second diameter being smaller than the first diameter.

[0015] Alternatively or additionally to any of the above embodiments, the actuation mechanism further includes a first roller wheel coupled to the housing, an outer circumferential surface of the first roller wheel positioned adjacent to an outer circumferential surface of the first thumb wheel such that the first elongated medical device can be positioned between the outer circumferential surface of the first roller wheel and the outer circumferential surface of the first thumb wheel, and rotation of the first thumb wheel causes rotation of the first roller wheel to move the first elongated medical device through the working channel of the endoscope.

[0016] Alternatively or additionally to any of the above-described embodiments, the housing includes a channel extending from an outer surface of the housing into a portion of a wall of the housing, the channel configured to receive a proximal end of a tubular member of the first elongate medical device, the proximal end of the tubular member of the first elongate medical device being fixedly attached to the channel.

[0017] Alternatively or additionally to any of the above described embodiments, the channel is configured to receive an elongate member of the first elongate medical device extending within the lumen of the tubular member of the first elongate medical device.

[0018] Alternatively or additionally, the actuation mechanism further includes a rotatable cap coupled to the housing, the proximal end of the elongate member being attached to the rotatable cap such that rotation of the rotatable cap moves the elongate member within the lumen of the tubular member of the first elongate medical device.

[0019] Another example is an endoscopic medical device. The endoscopic medical device includes a handle having a proximal end region and a distal end region, an elongated shaft coupled to and extending distally from the distal end region of the handle, and an actuation assembly coupled to the proximal end region of the handle. The actuation assembly includes a housing, a first thumb wheel coupled to the housing, and a second thumb wheel coupled to the housing. Rotation of the first thumb wheel moves a first elongated medical device through the elongated shaft. Rotation of the second thumb wheel moves a second medical device through the elongated shaft.

[0020] Alternatively or additionally to any of the above embodiments, rotation of the first thumb wheel to move the first medical device occurs independently from rotation of the second thumb wheel to move the second medical device.

[0021] Alternatively or additionally, the actuation assembly further includes a first drive wheel and a first roller wheel coupled to the housing. The first drive wheel is configured to be rotated by the first thumb wheel. The actuation assembly further includes a second drive wheel and a second roller wheel coupled to the housing. The second drive wheel is configured to be rotated by the second thumb wheel. The first drive wheel and the first roller wheel are configured to cooperatively apply a force on a first medical device positioned therebetween. The second drive wheel and the second roller wheel are configured to cooperatively apply a force on a second medical device positioned therebetween.

[0022] Alternatively or additionally to any of the above embodiments, rotation of the first thumb wheel rotates the first drive wheel and the first roller wheel in an opposite rotational direction to move the first elongate medical device through the elongate shaft, and rotation of the second thumb wheel rotates the second drive wheel and the second roller wheel in an opposite rotational direction to move the second elongate medical device through the elongate shaft.

[0023] Alternatively or additionally to any of the above embodiments, the first thumb wheel includes a first diameter and the first drive wheel includes a second diameter, the second diameter being smaller than the first diameter.

[0024] Another example is an actuation assembly for an endoscope. The actuation assembly includes a housing configured to attach to a handle of the endoscope, a thumb wheel coupled to the housing, and a rotation cap coupled to the housing. Rotation of the thumb wheel causes movement of a first elongated shaft within a working channel of the endoscope. The rotation cap is coupled to a second elongated shaft extending within a lumen of the first elongated shaft. Rotation of the rotation cap causes movement of the second elongated shaft within the lumen of the first elongated shaft.

[0025] Alternatively or additionally to any of the above described embodiments, rotation of the thumb wheel moves both the first elongate shaft and the second elongate shaft together within the working channel of the endoscope.

[0026] Alternatively or additionally to any of the above embodiments, the rotatable cap is actuatable between a retracted position and an extended position, the rotatable cap being biased towards the retracted position.

[0027] Alternatively or additionally to any of the above embodiments, the actuation assembly further includes a drive wheel having a circumferential surface in contact with both the thumb wheel and the first elongated shaft.

[0028] The above summary of some embodiments is not intended to describe each disclosed embodiment or every implementation of the present disclosure. The following figures and detailed description more particularly exemplify these embodiments.

[0029] The present disclosure can be more fully understood from the following detailed description considered in conjunction with the accompanying drawings, in which: [Brief explanation of the drawings]

[0030] [Figure 1] 1 is a perspective view of an exemplary medical device. [Figure 2] 2 is another perspective view of the exemplary medical device shown in FIG. 1. [Figure 3] 2 is another perspective view of the exemplary medical device shown in FIG. 1. [Figure 4] FIG. 4 is an exploded view of components of the shaft advancement mechanism of the medical device shown in FIG. 3. [Figure 5A] FIG. 2 is a detailed view of the shaft advancement mechanism of the medical device shown in FIG. 1. [Figure 5B] 2 is another detailed view of the shaft advancement mechanism of the medical device shown in FIG. 1. [Figure 6] FIG. 1 is a perspective view of another exemplary medical device. [Figure 7] 7 is another perspective view of the exemplary medical device shown in FIG. 6. [Figure 8] FIG. 8 is a detailed view of the shaft advancement mechanism of the medical device shown in FIG. 7. [Figure 9] 9A-9C illustrate exemplary steps for advancing a wire within the portion of the medical device shown in FIGS. 6-8. [Figure 10] 9A-9C illustrate exemplary steps for advancing a wire within the portion of the medical device shown in FIGS. 6-8. [Figure 11] FIG. 1 is a perspective view of another exemplary medical device. [Figure 12] FIG. 12 is a detailed view of the shaft advancement mechanism of the medical device shown in FIG. [Figure 13]13A-13D illustrate exemplary steps for advancing multiple medical device shafts within the portion of the medical device shown in FIGS. 11-12. [Figure 14] 13A-13D illustrate exemplary steps for advancing multiple medical device shafts within the portion of the medical device shown in FIGS. 11-12. [Figure 15] 13A-13D illustrate exemplary steps for advancing multiple medical device shafts within the portion of the medical device shown in FIGS. 11-12. [Figure 16] FIG. 1 is a side view of another exemplary medical device. [Figure 17] FIG. 17 is a perspective view of the exemplary medical device shown in FIG. 16. [Figure 18A] FIG. 10 is a perspective view of another configuration of the shaft advancement mechanism. [Figure 18B] FIG. 18B is a side view of the shaft advancement mechanism of FIG. 18A.

[0031] While the present disclosure is susceptible to various modifications and alternative forms, specifics thereof are shown by way of example in the drawings and will be described in detail below. It is to be understood, however, that the intention is not to limit the disclosure to the particular embodiments described. On the contrary, the intention is to cover all modifications, equivalents, and alternatives falling within the spirit and scope of the disclosure. DETAILED DESCRIPTION OF THE INVENTION

[0032] The following description should be read with reference to the drawings, which are not necessarily to scale and in which like reference numerals indicate like elements throughout the several views. The detailed description and drawings are intended to illustrate the present disclosure and not to limit it. Those skilled in the art will recognize that the various elements described and / or illustrated can be arranged in various combinations and configurations without departing from the scope of the present disclosure. The detailed description and drawings set forth exemplary embodiments of the present disclosure. However, for purposes of clarity and ease of understanding, not all features and / or elements may be shown in every drawing, but these features and / or elements can nevertheless be understood to be present unless otherwise specified.

[0033] For the following defined terms, the following definitions shall apply, unless a different definition is provided in the claims or elsewhere in this specification.

[0034] As used herein, all numerical values ​​are assumed to be modified by the term "about," whether explicitly stated or not. The term "about" in the context of numerical values ​​generally refers to a range of numbers that one of ordinary skill in the art would consider identical (e.g., having the same function or result) to the recited value. In many instances, the term "about" may include numbers that are rounded to the nearest significant figure. Other uses of the term "about" (e.g., in contexts other than numerical values) can be assumed to have the ordinary and customary definition of the term that is understood in the context of this specification and is not inconsistent therewith, unless otherwise specified.

[0035] The recitation of numerical ranges by endpoints includes all numbers within that range, inclusive of the endpoints (e.g., 1 to 5 includes 1, 1.5, 2, 2.75, 3, 3.80, 4, and 5).

[0036] Although some suitable dimensions, ranges, and / or values ​​for various components, features, and / or specifications are disclosed, those skilled in the art, alerted by the present disclosure, will understand that the desirable dimensions, ranges, and / or values ​​may deviate from those explicitly disclosed.

[0037] As used in this specification and the claims, the singular forms "a," "an," and "the" include plural referents unless the context clearly dictates otherwise. As used in this specification and the claims, the term "or" is generally used to include "and / or" unless the context clearly dictates otherwise. For ease of understanding, it should be noted that even though certain features of the present disclosure may be multiple or repeated within an embodiment of the present disclosure, these features may be described in the singular. Each instance of these features may include and / or be encompassed by the singular disclosure, unless expressly stated to the contrary. For purposes of brevity and clarity, not all elements of the present disclosure are shown in each figure and discussed in detail below. However, it will be understood that when more than one element is present, the following discussion may equally apply to any and / or all of these elements, unless expressly stated to the contrary. Additionally, for purposes of clarity, not every instance of some elements or features may be shown in each figure.

[0038] Relative terms such as “proximal,” “distal,” “advance,” “retract,” and variations thereof may generally be determined with respect to the positioning, orientation, and / or operation of various elements relative to a user / operator / operator of a device, with “proximal” and “retract” indicating or meaning closer to or toward the user, and “distal” and “advance” indicating or meaning farther from or away from the user. In some instances, the terms “proximal” and “distal” may be assigned arbitrarily in an attempt to facilitate understanding of the present disclosure, but such instances will be readily apparent to those skilled in the art. Other relative terms such as “upstream,” “downstream,” “inflow,” and “outflow” refer to the direction of fluid flow within a body lumen, a lumen such as a blood vessel, or within a device. Still other relative terms such as “axial,” “circumferential,” “longitudinal,” “lateral,” “radial,” etc., and / or variations thereof, generally refer to directions and / or orientations relative to a central longitudinal axis of a structure or device of the present disclosure.

[0039] The term "extent" can be understood to mean the minimum measurement of the dimension described or identified unless "minimum" precedes such extent or dimension or the extent or dimension is identified as "minimum." For example, "outer extent" can be understood to mean the outer dimension, "radial extent" can be understood to mean the radial dimension, "longitudinal extent" can be understood to mean the longitudinal dimension, and so forth. Examples of "extent" can vary (e.g., axially, longitudinally, laterally, radially, circumferentially, etc.) and will be apparent to those skilled in the art from the particular context of use. Generally, "extent" can be considered the largest possible dimension measured according to the intended use, whereas "minimum extent" can be considered the smallest possible dimension measured according to the intended use. In some cases, "extent" can generally be measured orthogonally within a plane and / or cross-section, but can be measured differently as apparent from the particular context, such as, but not limited to, angularly, radially, circumferentially (e.g., along an arc), etc.

[0040] The terms "monolithic" and "unitary" shall generally mean one or more elements fabricated or constructed from a single structure or base unit / element. Monolithic element and / or unitary element shall exclude structures and / or features fabricated by assembling or joining together multiple individual structures or elements.

[0041] It should be noted that references herein to "embodiments," "some embodiments," "other embodiments," etc., indicate that the described embodiments may include particular features, structures, or characteristics, but that not all embodiments necessarily include these particular features, structures, or characteristics. Moreover, such phrases do not necessarily refer to the same embodiment. Furthermore, when particular features, structures, or characteristics are described with respect to an embodiment, it is believed that those skilled in the art will recognize that these particular features, structures, or characteristics can also be implemented with respect to other embodiments, unless expressly stated to the contrary. That is, those skilled in the art will understand that the various individual elements described below, even if not specified in specific combinations, are still contemplated as being combinable or configurable with each other to form other or additional embodiments or to complement and / or extend the described embodiments.

[0042] For purposes of clarity, certain distinguishing numerical nomenclature (e.g., first, second, third, fourth, etc.) may be used throughout this specification and / or claims to name and / or distinguish among various features described and / or claimed. It should be understood that this numerical nomenclature is not intended to be limiting, but is merely exemplary. In some embodiments, for purposes of brevity and clarity, there may be variations and departures from previously used numerical nomenclature. That is, a feature identified as a "first" element may later be referred to as a "second," "third," etc., or may be omitted entirely, and / or a different feature may be referred to as the "first" element. The meaning and / or designation in each instance will be apparent to one of ordinary skill in the art.

[0043] As discussed above, the present disclosure relates to medical devices having a handle that can be designed to manipulate the distal end of an endoscope shaft as well as other medical devices used in conjunction with the endoscope. For example, the medical device can include a ureteroscope having a handle that includes a manual medical device advancement system. In these examples, the medical device advancement system can include one or more drive wheels that can be operated by only a single thumb of the physician.

[0044] FIG. 1 is a perspective view of an exemplary medical device 10. The medical device 10, depicted as an endoscope, may be any of several different types of medical devices utilized in various medical interventions. For example, a particular type of medical device 10 may be identified by the particular anatomical structure desired to be reached. For example, the medical device 10 may be a ureteroscope (e.g., a LithoVue® endoscope), bronchoscope, hysteroscope, cystoscope, colonoscope, duodenoscope, esophagoscope, or any other type of endoscope. The medical device 10 may include a handle 12 having a distal end 14, a proximal end 16, and an intermediate region 18 positioned between the distal end 14 and the proximal end 16. Note that the terms “proximal” and “distal,” as used herein, are intended to mean directions toward (proximal) and away from (distal) a user (e.g., a physician) of the device. Additionally, the medical device 10 may include an elongated shaft 20 extending distally from the handle 12. Generally, the elongate shaft 20 may take the form of a polymeric or metallic tube. In some embodiments, the elongate shaft 20 may be constructed with a reinforcing braid, a reinforcing liner, a reinforcing web, a reinforcing fabric, or the like.

[0045] The elongate shaft 20 may include a lumen defining a working channel that extends through the shaft 20 from its distal end region to an access port 30 (e.g., a Y-connector) that may be engaged with the handle 12 or another portion of the medical device 10. Although the elongate shaft 20 is described in FIG. 1 as having a single working channel, it can be appreciated that in other embodiments, the medical device 10 may include multiple working channels as desired.

[0046] Additionally, the handle 12 may include a deflection knob 40 or other actuator that can be used to control the movement (e.g., deflection) of the distal tip of the shaft 20 during surgery. For example, the deflection knob 40 may control the up and down movement or deflection of the distal tip of the shaft 20. In some cases, the deflection knob may be a self-locking or friction-locking type knob that maintains itself (and the elongate shaft 20) in its deflected position after being released. The handle 12 may further include one or more buttons 24 that can be used to activate the aspiration or delivery of fluids, such as air, saline, and / or water, through the lumen of the medical device 10 or to perform other functions as desired. These are merely examples. Other variations and / or features suitable for the medical device 10 are contemplated.

[0047] In some embodiments, a cable 22 extends from the handle 12 and is configured for attachment to an electronic device (not shown), such as a computer system, console, microcontroller, etc., to provide power, analyze endoscopic data, control the endoscopic intervention, or perform other functions. In some embodiments, the electronic device to which the cable 22 connects may have the capability to recognize and exchange data with other endoscopic accessories.

[0048] As discussed above, FIG. 1 illustrates that the endoscope handle 12 can be used in conjunction with additional medical devices during a medical procedure. For example, the medical device 10 can be a ureteroscope (e.g., a flexible ureteroscope) utilized in the fragmentation and removal of kidney stones (e.g., kidney stones). Thus, in some instances, the handle 12 can be used in conjunction with a laser fiber 36 utilized to break up the kidney stones and a retrieval device (e.g., a retrieval basket) utilized to remove kidney stone fragments. Furthermore, the handle 12 (and its various components) can be utilized to manipulate the elongate shaft 20 as well as the laser fiber 36 and / or retrieval device 38, which can extend through portions of both the handle 12 and the shaft 20. While the following disclosure may generally describe the medical device 10 as being used in conjunction with the laser fiber 36 and / or retrieval device 38, it can be appreciated that the medical device 10 (and its components) can be used in conjunction with any elongate medical device, including a sheath, a tubular member, a guidewire, or a laser, etc.

[0049] 1 further illustrates that the laser fiber 36 can pass through the first hub 32a of the access port 30, continue through the distal end 14 of the handle 12, and enter the working channel of the elongate shaft 20. After passing the length of the working channel of the elongate shaft 20, the laser fiber 36 can exit the distal end of the elongate shaft 20 (not shown in FIG. 1).

[0050] FIG. 1 shows a retrieval device 38 entering a shaft advancing device 34 coupled to the proximal end region 16 of the handle 12. The retrieval device 38 may include a tubular shaft 37 having a lumen extending from its distal end to its proximal end. After passing through the shaft advancing device 34, the retrieval device 38 may enter the lumen of the first connecting tube 26 (note that the proximal end of the first connecting tube 26 may be fixedly attached to the shaft advancing device 34). The retrieval device 38 may continue through the lumen of the first connecting tube 26 and into the first hub 32a of the access port 30. While FIG. 1 shows the access port 30 including three hubs, it can be appreciated that the access port 30 may include more or less than three hubs. For example, the access port 30 may include one, two, three, four, five, six, or seven or more hubs.

[0051] Additionally, the access port 30 can include a variety of different shapes that can include one or more hubs configured to connect to one or more connecting tubes. Additionally, in some instances, the access port 30 can be omitted from the handle 12. In these instances, the handle housing itself can include one or more hubs extending directly from its exterior surface. These hubs can be utilized to attach to one or more connecting tubes.

[0052] 1 further illustrates that retrieval device 38 can pass through first hub 32a of access port 30, continue through distal end 14 of handle 12, and enter the working channel of elongate shaft 20 or an additional working channel of elongate shaft 20. After passing the length of the working channel of elongate shaft 20, retrieval device 38 can exit the distal end of elongate shaft 20 as shown in FIG.

[0053] 1 further illustrates that in some instances, the retrieval device 38 can include an end effector, such as a retrieval basket 50, for collecting and / or grasping particulate matter, such as kidney stone fragments. The retrieval device 38 can include a retrieval wire 39 extending within the lumen of the tubular shaft 37 of the retrieval device 38 to operate the end effector, such as the retrieval basket 50. For example, FIG. 1 illustrates that in some instances, the retrieval wire 39 can enter the lumen of the tubular shaft 37 of the retrieval device 38 at its proximal end, pass through the lumen of the tubular shaft 37 of the retrieval device 38 (and thus pass through the first connecting tube 26 of the handle 12, the first hub 32a, the distal end 14, and further through the working channel of the elongate shaft 20), and then exit the distal end of the tubular shaft 37 of the retrieval device 38.

[0054] 1 depicts retrieval wire 39 as including retrieval basket 50, it can be appreciated that retrieval wire 39 can include a variety of different end effectors for use with retrieval device 38. For example, retrieval wire 39 can include a retrieval net, forceps, a fixation device, a stone-pushing device, or other similar medical device.

[0055] It can be appreciated that in some instances, the retrieval basket 50 can be transitioned from a first, unexpanded configuration to a second, expanded configuration by longitudinally actuating the retrieval wire 39 relative to the tubular member of the retrieval device 38. During use, when in the expanded configuration, the retrieval basket 50 can be utilized to capture a kidney stone or its fragments. After capture within the retrieval basket 50, a clinician can remove the kidney stone and / or fragments from the body by retracting the retrieval basket 50 proximally toward the distal end of the tubular shaft 37 of the retrieval device 38 to close the retrieval basket 50 around the kidney stone and / or fragments. It can be appreciated that the kidney stone and / or fragments can remain trapped within the retrieval basket 50 while remaining outside the lumen of the retrieval device 38. To remove the kidney stone and / or fragments from the body, a clinician can withdraw the retrieval device 38 proximally from the patient's body through the working channel of the elongate shaft 20 of the medical device 10.

[0056] As discussed above with respect to the retrieval device 38, FIG. 1 shows the laser fiber 36 entering the shaft advancing device 34 coupled to the proximal end region 16 of the handle 12. After passing through the shaft advancing device 34, the laser fiber 36 may enter the lumen of the second connecting tube 28 (note that the proximal end of the second connecting tube 28 may be fixedly attached to the shaft advancing device 34). The laser fiber 36 may continue through the lumen of the second connecting tube 28 and into the second hub 32b of the access port 30. It can be appreciated that FIG. 1 shows the retrieval device 38 extending from the distal end of the elongate shaft 20, while the distal end of the laser fiber 36 is shown in dashed lines for illustrative purposes only. Thus, it can be appreciated that during a medical procedure, only one or the other of the laser fiber 36 or the retrieval device 38 (including the retrieval wire 39 disposed within the lumen of the tubular shaft 37 of the retrieval device 38) can occupy the working channel of the elongate shaft 20, while the other of the laser fiber 36 and the retrieval device 38 can be disposed proximal to the access port 30 within either the first connecting tube 26 or the second connecting tube 28. In other cases, the laser fiber 36 can occupy a first working lumen of the elongate shaft 20, while the retrieval device 38, including its tubular shaft 37 and the retrieval wire 39 extending therethrough, occupies a second working lumen of the elongate shaft 20. It may be appreciated that in some examples, each of the first connecting tube 26 and the second connecting tube 28 may be transparent or translucent, which allows the clinician to see the distal end of the laser fiber 36 and the distal end of the retrieval device 38 positioned within these connecting tubes when they are withdrawn from the working channel of the elongate shaft 20 to allow the other device to occupy the working channel of the elongate shaft 20.It may be desirable for the clinician to be able to visually confirm that the distal end of the retrieval device 38 or the distal end of the laser fiber 36 is positioned in the other of the first connecting tube 26 or the second connecting tube 28, respectively, when advancing either the retrieval device 38 or the laser fiber 36 distally into the working channel of the elongate shaft 20.

[0057] For example, a medical procedure for removing a kidney stone may include operating the shaft advancing device 34 (described in more detail below) to advance the laser fiber 36 into the second connecting tube 28 so that the laser fiber 36 is positioned immediately proximal to the second hub 32b of the access port 30. As discussed above, the distal end of the laser fiber 36 may be visible within the transparent or translucent connecting tube 28 when positioned proximal to the second hub 32b. The shaft advancing device 34 may then be utilized to advance the retrieval device 38 (including the tubular shaft 37 of the retrieval device 38 and the retrieval wire 39 positioned therein) into the first connecting tube 26 so that the retrieval device 38 is positioned immediately proximal to the first hub 32a of the access port 30. As discussed above, the distal end of the retrieval device 38 may be visible within the transparent or translucent connecting tube 26 when positioned proximal to the first hub 32a. In this configuration, the retrieval device 38 and the laser fiber 36 may be said to be "on standby" within their respective connecting tubes 26 / 28 to allow the other to be advanced into the working channel of the elongate shaft 20.

[0058] An exemplary next step in the procedure may include the physician manipulating the shaft advancement device 34 to advance the laser fiber 36 through the working channel of the elongate shaft 20 to the target site, thereby utilizing the laser fiber 36 to fragment the kidney stone. The physician may then utilize the advancement device 34 to retract the laser fiber 36 proximally until the distal end of the laser fiber 36 is positioned proximal to the second hub 32b and placed back into the second connecting tube 28. It may be appreciated that the laser fiber 36 is removed from the working channel of the elongate shaft 20 when the distal tip of the laser fiber 36 is visible through the transparent or translucent connecting tube 28. It may be appreciated that retracting the laser fiber 36 into the second connecting tube 28 may open the working channel of the elongate shaft 20, allowing the retrieval device 38 to thereafter be advanced therethrough. Thus, the next step in the procedure may include the physician manipulating the shaft advancement device 34 to distally advance the retrieval device 38 through the working channel of the elongate shaft 20 to the target site, which may deploy a retrieval basket 50 distal to the distal end of the elongate shaft 20 of the medical device 10 to capture the kidney stone and / or debris.

[0059] As discussed above, the kidney stones and / or debris can remain trapped within the retrieval basket 50 while the clinician withdraws the retrieval device 38 and elongate shaft 20 of the medical device 10 from the patient's body. The medical device 10 can then be reinserted into the body to retrieve additional kidney stones and / or debris, if desired.

[0060] 2-5B and the corresponding discussion below describe the components and function of shaft advancement device 34.

[0061] FIG. 2 illustrates that the shaft advancing device 34 can be removably coupled to the proximal end region 16 of the handle 12. In other implementations, the shaft advancing device 34 can be otherwise coupled to the proximal end region 16 of the handle 12. As discussed above in FIG. 1, FIG. 2 illustrates the retrieval device 38 and the laser fiber 36 passing through the shaft advancing device 34 and further through the first and second connecting tubes 26 and 28, respectively. Although the shaft advancing device 34 has been described as being removably coupled to the handle 12, in some embodiments it can be integral with and / or fixedly attached to the handle 12, and thus removal of the shaft advancing device 34 from the handle 12 is not intended.

[0062] As shown in FIG. 2 , the shaft advancing device 34 can be coupled to the handle 12 by insertion of an engagement feature of the shaft advancing device 34 into a slot 42 positioned in the proximal end region 16 of the handle 12. As shown below in FIG. 3 , the slot 42 can be designed to receive a mandrel (shown in FIG. 3 ) positioned on a housing component of the shaft advancing device 34. Insertion of the mandrel into the slot 42 of the handle 12 is depicted by arrow 44 in FIG. 2 . In other embodiments, the shaft advancing device 34 can include a different engagement feature (such as, for example, a post, pin, or fastener) that engages with the slot 42 of another engagement feature of the handle 12. It can be appreciated that the shaft advancing device 34 can be packaged as a separate device that is optionally coupled to the handle 12 when desired. For example, a physician can choose to attach the shaft advancing device 34 prior to a procedure that includes manipulation of the handle 12 with additional medical devices, such as the laser fiber 36 and retrieval device 38. It can be appreciated that the shaft advancing device 34 can be detached from the handle 12 when desired.

[0063] As discussed above, Figure 3 illustrates the insertion of the mandrel 46 of the shaft advancement device 34 into the slot 42 of the handle 12. Additionally, Figure 3 illustrates that the shaft advancement device 34 may further include a post (e.g., clip) 48 designed to be inserted into a recess 52 positioned along the distal end region 16 of the handle 12. It can be appreciated that the recess 52 may be positioned adjacent an upper region of the slot 42.

[0064] It can be further appreciated that engagement of the mandrel 46 within the slot 42, in combination with insertion of the flat portion of the post or clip 48 within the recess 52, can limit rotation of the shaft advancing device 34 when coupled to the handle 12, and further provide sufficient retention force to prevent the shaft advancing device 34 from inadvertently becoming detached from the handle 12 during a medical procedure. For example, the dimensions of the mandrel 46 and the dimensions of the post or clip 48 can be designed to provide a press-fit or interlocking fit with the slot 42 and recess 52, respectively.

[0065] Figure 4 shows an exploded view of the above-described shaft advancement device 34. For clarity, the first connecting shaft 26, the second connecting shaft 28, the laser fiber 36, and the retrieval device 38 have been omitted from Figure 4.

[0066] FIG. 4 illustrates that the shaft advancement device 34 may include an inner housing 62 (e.g., a first housing member) and an outer housing 54 (e.g., a second housing member) that may be positioned (e.g., “sandwiched”) between a first thumb wheel 56 and a second thumb wheel 57. The first thumb wheel 56 may be coupled to the inner housing 62 by the passage of a stem 64 of the inner housing 62 through an opening 66 therein. FIG. 4 illustrates that the stem 64 of the inner housing 62 may be positioned within an approximately central region of the inner housing 62. Furthermore, FIG. 4 illustrates that the stem 64 may be shaped as an approximately hexagon. While FIG. 4 illustrates the stem 64 including a hexagonal shape, it may be appreciated that the stem 64 may include a variety of shapes. For example, it is contemplated that the stem 64 may include a cylindrical, triangular, polygonal, square, or other similar shape.

[0067] Similarly, the second thumb wheel 57 can be coupled to the inner housing 62 by the passage of the mandrel 46 (not visible in FIG. 4 but shown in FIG. 3 ) of the inner housing 62 through the opening 68 in the second thumb wheel 57. FIG. 4 illustrates that the mandrel 46 of the inner housing 62 can be positioned generally within a central region of the inner housing 62. It can be appreciated that the mandrel 46 can be axially aligned with the mandrel 64. Furthermore, FIG. 4 illustrates that the mandrel 46 can be shaped as a generally cylindrical shape. While FIG. 4 illustrates the mandrel 46 including a cylindrical shape, it can be appreciated that the mandrel 46 can include a variety of shapes. For example, it can be appreciated that the mandrel 46 can include a hexagonal, triangular, polygonal, square, or other similar shape. Furthermore, it can be appreciated that the first thumb wheel 56 and the second thumb wheel 57 can each be press-fit onto the mandrel 64 and the mandrel 46, respectively, while allowing rotation of the first and second thumb wheels 56 / 57 relative to the mandrels.

[0068] 4 further illustrates that each of the first thumb wheel 56 and the second thumb wheel 57 can include a band of material extending circumferentially around its circumference. For example, the first thumb wheel 56 can include a band of material 70 extending circumferentially around its circumference. Similarly, the second thumb wheel 57 can include a band of material 72 extending circumferentially around its circumference. The materials used to construct the band of material 70 and the band of material 72 can be designed to generally include materials that allow a user to grip while operating the first thumb wheel 56 and / or the second thumb wheel 57. For example, the band of material 70 and the band of material 72 can include rubber, silicone, nitrile butadiene rubber, a thermoplastic elastomer, neoprene, or similar materials.

[0069] Additionally, in some examples, band of material 70 and band of material 72 can include a resilient material. Utilizing a resilient material to construct band of material 70 and band of material 72 can be advantageous because the resilient material can be resistant to being removed from first thumb wheel 56 and / or second thumb wheel 57. In other words, the resilient material can exert a compressive force on the outer circumferential surface of first thumb wheel 56 and / or second thumb wheel 57. Furthermore, band of material 70 and band of material 72 can include a rough or textured surface suitable for coming into contact with both the other wheel and the user's thumb.

[0070] It can be appreciated that when assembled, the first thumb wheel 56 and / or the second thumb wheel 57 can be rotated in either a clockwise or counterclockwise direction about the axles 64 and 46, respectively. Additionally, as described in more detail below, a physician can manually rotate the first thumb wheel 56 and / or the second thumb wheel 57 using the thumb (or another finger) of their hand gripping the handle 12 of the medical device 10. It can be appreciated that each of the first thumb wheel 56 and / or the second thumb wheel 57 can be rotated in either direction (e.g., each of the first thumb wheel 56 and / or the second thumb wheel 57 can be rotated in a clockwise or counterclockwise direction).

[0071] FIG. 4 illustrates that the shaft advancement device 34 can include a first drive wheel 58. The first drive wheel 58 can be coupled to the inner housing 62 through a pin 74b extending from the face of the inner housing 62. It can be appreciated that the first drive wheel 58 can rotate in a clockwise or counterclockwise direction about the axis of the pin 74b. FIG. 4 further illustrates that the first drive wheel 58 can include a band of material 47 extending circumferentially around its periphery. The circumferential surface of the first drive wheel 58 can be in direct contact with the circumferential surface of the first thumb wheel 56. The band of material 47 can be similar in form and function to the band of material 70 described above. FIG. 4 further illustrates that the first drive wheel 58 can be in contact with the first thumb wheel 56 (e.g., the band of material 70 of the first thumb wheel 56 can be in direct contact with the band of material 47 of the first drive wheel 58).

[0072] FIG. 4 further illustrates that the shaft advancement device 34 can include a first roller wheel 60. It can be seen that the first roller wheel 60 can be coupled to the inner housing 62 through a pin 74a extending from the face of the inner housing 62. It can be seen that the first roller wheel 60 can rotate in a clockwise or counterclockwise direction about the axis of the pin 74a. Furthermore, FIG. 4 illustrates that the first roller wheel 60 can include a band of material 49 extending circumferentially around its periphery. The band of material 49 can be similar in form and function to the band of material 70 described above. The circumferential surface of the first drive wheel 58 can be disposed adjacent to the circumferential surface of the first roller wheel 60. For example, FIG. 4 shows that the first roller wheel 60 can be in contact with the first drive wheel 58 (e.g., the band of material 47 of the first drive wheel 58 can be in direct contact with the band of material 49 of the first roller wheel 58), or a small gap may remain between them suitable for placement of the tubular shaft 37 of the retrieval device 38 therein.

[0073] As explained in more detail below, because the first thumb wheel 56 is in direct contact with the first drive wheel 58, rotation of the first thumb wheel 56 will cause rotation of the first drive wheel 58 in an opposite direction. For example, clockwise rotation of the first thumb wheel 56 (as viewed from the outer surface of the thumb wheel 56) will cause counterclockwise rotation of the first drive wheel 58. Similarly, because the first drive wheel 58 is in direct contact with the first roller wheel 60, rotation of the first drive wheel 58 will cause rotation of the first roller wheel 60 in an opposite direction. For example, counterclockwise rotation of the first drive wheel 58 will cause clockwise rotation of the first roller wheel 60. It can further be seen that as a result of the rotation of the first thumb wheel 56, the first roller wheel 60 is rotated in the same direction as the first thumb wheel 56 (although the first drive wheel 58 is rotated in the opposite direction from both the first thumb wheel 56 and the first roller wheel 60).

[0074] The first thumb wheel 56 can have a diameter larger than the diameter of the first drive wheel 58 to provide a mechanical advantage. For example, the diameter of the first thumb wheel 56 can be two or more times larger, three or more times larger, or four or more times larger than the diameter of the first drive wheel 58. Thus, one full revolution of the first thumb wheel 56 can cause a larger revolution than one full revolution of the first drive wheel 58. In some cases, the first thumb wheel 56 can be sized relative to the first drive wheel 58 in a ratio of, for example, 2:1, 3:1, 4:1, or 5:1.

[0075] FIG. 4 illustrates that the shaft advancement device 34 can include a second drive wheel 59. The second drive wheel 59 can be coupled to the inner housing 62 through a pin (not visible in FIG. 4) extending from the face of the inner housing 62. It can be appreciated that the second drive wheel 59 can rotate in a clockwise or counterclockwise direction. FIG. 4 further illustrates that the second drive wheel 59 can include a band of material 51 extending circumferentially around its periphery. The circumferential surface of the second drive wheel 59 can be in direct contact with the circumferential surface of the second thumb wheel 57. The band of material 51 can be similar in form and function to the band of material 72 described above. FIG. 4 further illustrates that the second drive wheel 59 can be in contact with the second thumb wheel 57 (e.g., the band of material 72 of the second thumb wheel 57 can be in direct contact with the band of material 51 of the second drive wheel 59).

[0076] FIG. 4 illustrates that the shaft advancement device 34 can include a second roller wheel 61. The second roller wheel 61 can be coupled to the inner housing 62 through a pin (not visible in FIG. 4) extending from the face of the inner housing 62. It can be appreciated that the second roller wheel 61 can rotate in a clockwise or counterclockwise direction. Furthermore, FIG. 4 illustrates that the second roller wheel 61 can include a band of material 53 extending circumferentially around its circumference. The band of material 53 can be similar in form and function to the band of material 72 described above. The circumferential surface of the second drive wheel 59 can be positioned adjacent to the circumferential surface of the second roller wheel 61. For example, FIG. 4 illustrates that the second roller wheel 61 can be in contact with the second drive wheel 59 (e.g., the band of material 51 of the second drive wheel 59 can directly contact the band of material 53 of the second roller wheel 61), or a small gap suitable for placement of the laser fiber 36 therein can remain.

[0077] As explained in more detail below, because the second thumb wheel 57 is in direct contact with the second drive wheel 59, rotation of the second thumb wheel 57 will cause rotation of the second drive wheel 59 in an opposite direction. For example, counterclockwise rotation of the second thumb wheel 57 (as viewed from the outer surface of the second thumb wheel 57) will cause clockwise rotation of the second drive wheel 59. Similarly, because the second drive wheel 59 is in direct contact with the second roller wheel 61, rotation of the second drive wheel 59 will cause rotation of the second roller wheel 61 in an opposite direction. For example, clockwise rotation of the second drive wheel 59 will cause counterclockwise rotation of the second roller wheel 61. It can further be seen that rotation of second thumb wheel 57 results in second roller wheel 61 rotating in the same direction as second thumb wheel 57 (although second drive wheel 59 rotates in the opposite direction to both second thumb wheel 57 and second roller wheel 61).

[0078] The second thumb wheel 57 can have a diameter larger than the diameter of the second drive wheel 59 to provide a mechanical advantage. For example, the diameter of the second thumb wheel 57 can be two or more times larger, three or more times larger, or four or more times larger than the diameter of the second drive wheel 59. Thus, one full revolution of the second thumb wheel 57 can cause a larger revolution than one full revolution of the second drive wheel 59. In some cases, the second thumb wheel 57 can be sized relative to the second drive wheel 59 in a ratio of, for example, 2:1, 3:1, 4:1, or 5:1.

[0079] It can be appreciated that one or more of the "wheels" described herein (all wheels described with respect to FIG. 4) may not necessarily be in direct contact with one another to rotate with one another. Rather than in direct contact with one another, in some embodiments, one or more of the wheels can be connected to pulleys, gears, or the like attached to the wheels through a belt, chain, or the like. For example, each of the independent wheels can include a gear, in which case the gears of the two wheels are coupled to one another through a drive belt or drive chain. It can be appreciated that rotation of one wheel will cause the other wheel to rotate through a drive belt or drive chain connection. Furthermore, gear ratios can be used to adapt the speed / force of the drive wheels.

[0080] FIG. 4 further illustrates that the housing of the shaft advancement device 34 can include an outer housing 54. The outer housing 54 can be designed to cover a portion of the lateral (outward) surface of the first thumb wheel 56 and not cover the corresponding lateral (outward) surface of the second thumb wheel 57. However, in other cases, the outer housing 54 can be designed over the lateral (outward) surface of the second thumb wheel 57, as desired. FIG. 4 also illustrates that the outer housing 54 can include an opening 76 through which the mandrel 64 extends (e.g., the outer housing 54 can be attached to the inner housing 62 by engagement of the mandrel 64 through the opening 76).

[0081] Additionally, the outer housing 54 can be positioned over a portion of the inner housing 62, the first thumb wheel 56, the first drive wheel 58, the first roller wheel 60, the second drive wheel 59, and the second roller wheel 61. Referring back to FIGS. 2-3 , the outer housing 54 is shown positioned over a portion of the inner housing 62, the first thumb wheel 56, the first drive wheel 58, the first roller wheel 60, the second drive wheel 59, and the second roller wheel 61. Referring back to FIG. 2 , the mandrel 64 is shown extending through an opening 76 in the outer housing 54. It can further be seen that the outer housing 54 can include a channel 78 designed to receive an upper head portion 80 of the inner housing 62. Upper head portion 80 of inner housing 62 can be defined as the portion of inner housing 62 that includes first drive wheel 58, first roller wheel 60, second drive wheel 59, and second roller wheel 61. It can be seen from FIGS. 2-3 that when assembled, outer housing 54 can cover first drive wheel 58, first roller wheel 60, second drive wheel 59, and second roller wheel 61 while allowing a user to access and rotate first thumb wheel 56 and second thumb wheel 57.

[0082] Figure 5A shows a detailed view of shaft advancement device 34 (for clarity, outer housing 54 has been omitted from Figure 5A). In particular, Figure 5A shows upper head portion 80, including first drive wheel 58, first roller wheel 60, second drive wheel 59 (not visible in Figure 5A but shown in Figure 5B), and second roller wheel 61 (not visible in Figure 5A but shown in Figure 5B), within inner housing 62. Additionally, Figure 5A shows first drive wheel 58 in direct contact with first thumb wheel 56.

[0083] Additionally, Figure 5A shows laser fiber 36 extending through opening 84 formed in inner housing 62 and retrieval device 38 extending through opening 82 formed in inner housing 62 (it can be appreciated from the above discussion that retrieval wire 39 can extend through tubular shaft 37 of retrieval device 38, but is not visible in Figure 5A). Furthermore, Figure 5A shows that tubular shaft 37 of retrieval device 38 can be sandwiched (i.e., compressed) between first drive wheel 58 and first roller wheel 60 (e.g., between band of material 47 of first drive wheel 58 and band of material 49 of first roller wheel 60).

[0084] FIG. 5A further illustrates that the proximal end of the first connecting tube 26 can be fixedly attached to a housing, such as the inner housing 62. For example, the proximal end of the first connecting tube 26 can be attached to the inner housing 62 with an adhesive. Other attachment methods are contemplated for fixedly attaching the proximal end of the first connecting tube 26 to a housing (e.g., the inner housing 62). For example, the proximal end of the first connecting tube 26 can be flared, whereby the housing 62 can include a protrusion designed to engage and mate with the flared portion of the first connecting tube 26. In another example, the proximal end of the first connecting tube 26 can be expanded to fit over the barb splice element of the housing 62. FIG. 5A also illustrates that the retrieval device 38, or other elongated shaft of a medical device, can enter the lumen of the first connecting tube 26 after passing between the first drive wheel 58 and the first roller wheel 60 (the retrieval device 38 within the lumen of the first connecting tube 26 is shown in dashed lines).

[0085] 5A illustrates a mechanism (as described above) for advancing (or retracting) the retrieval device 38 into and out of the working channel of the elongate shaft 20 through operation of the first thumb wheel 56. As described above, clockwise rotation (indicated by arrow 85) of the first thumb wheel 56 will cause counterclockwise rotation (indicated by arrow 86) of the first drive wheel 58. Counterclockwise rotation of the first drive wheel 58 will move the retrieval device 38 distally (e.g., this rotation will drive / push the retrieval device 38 into the lumen of the first connecting tube 26). Furthermore, it can be seen that counterclockwise rotation of the first thumb wheel 56 reverses the rotation of the first drive wheel 58, thereby retracting the retrieval device 38 proximally.

[0086] It can be appreciated that the function of the first drive wheel 58 to move the retrieval device 38 relative to the first connecting tube 26 and relative to the working channel of the elongate shaft 20 is achieved by the compressive force exerted on the retrieval device 38 when the retrieval device 38 is sandwiched between the first drive wheel 58 and the first roller wheel 60. It can further be appreciated that the first drive wheel 58 and the first roller wheel 60 must be spaced apart from one another to allow the first drive wheel 58 to sufficiently advance the retrieval device 38 without sliding within the first connecting tube 26 (and the working channel of the elongate shaft 20), while also providing comfortable tactile feedback to the user from the first thumb wheel 56. In some examples, the first drive wheel 58 and / or the first roller wheel 60 can be spring-mounted such that the spacing between these wheels is adjustable for elongate shafts of medical devices having various outer diameters.

[0087] Figure 5B shows a rotation of Figure 5A to show the laser fiber 36 extending through an opening 84 formed in the inner housing 62. Additionally, Figure 5B shows that the laser fiber 36 can be sandwiched (i.e., pressed) between the second drive wheel 59 and the second roller wheel 61 (e.g., between the band of material 51 of the second drive wheel 59 and the band of material 53 of the first roller wheel 61).

[0088] FIG. 5B further illustrates that the proximal end of the second connecting tube 28 can be fixedly attached to a housing, such as the inner housing 62. For example, the proximal end of the second connecting tube 28 can be attached to the inner housing 62 with an adhesive. Other attachment methods are contemplated for fixedly attaching the proximal end of the second connecting tube 28 to a housing (e.g., the inner housing 62). For example, the proximal end of the second connecting tube 28 can be flared, whereby the housing 62 can include a protrusion designed to engage and mate with the flared portion of the second connecting tube 28. In another example, the proximal end of the second connecting tube 28 can be expanded to fit over the barb splice element of the housing 62. FIG. 5B further illustrates that the laser fiber 36 or other elongated shaft of a medical device can enter the lumen of the second connecting tube 28 after passing between the second drive wheel 59 and the second roller wheel 61 (the laser fiber 36 within the lumen of the second connecting tube 28 is shown in dashed lines).

[0089] 5B illustrates a mechanism (as described above) for advancing (or retracting) the laser fiber 36 into and out of the working channel of the elongate shaft 20 via operation of the second thumb wheel 57. As described above, counterclockwise rotation (indicated by arrow 87) of the second thumb wheel 57 will cause clockwise rotation (indicated by arrow 88) of the second drive wheel 59. Clockwise rotation of the second drive wheel 59 will move the laser fiber 36 distally (e.g., this rotation will drive / push the laser fiber 36 into the lumen of the second connecting tube 28). Furthermore, it can be seen that clockwise rotation of the second thumb wheel 57 reverses the rotation of the second drive wheel 59, thereby retracting the laser fiber 36 proximally.

[0090] It can be appreciated that the function of the second drive wheel 59 to move the laser fiber 36 relative to the second connecting tube 28 and relative to the working channel of the elongated shaft 20 is achieved by a compressive force exerted on the laser fiber 36 when the laser fiber 36 is sandwiched between the second drive wheel 59 and the second roller wheel 61. It can further be appreciated that the second drive wheel 59 and the second roller wheel 61 must be spaced apart from one another to allow the second drive wheel 59 to sufficiently advance the laser fiber 36 without sliding within the second connecting tube 28 (and the working channel of the elongated shaft 20) while also providing comfortable tactile feedback to the user from the second thumb wheel 57. In some examples, the second drive wheel 59 and / or the second roller wheel 61 can be spring-mounted such that the spacing between these wheels is adjustable for elongated shafts of medical devices having various outer diameters.

[0091] 6-10 show another exemplary medical device 100. The medical device 100 can be similar in form and function to the medical device 10 described above. For example, the medical device 100 can include a handle 112 having a distal end region 114, a proximal end region 116, and an intermediate region 118. The handle 112 can further include an elongate shaft 120 extending distally from the distal end region 114. The elongate shaft 120 can be similar in form and function to the elongate shaft 20 described above.

[0092] Additionally, handle 112 may include access port 130 (including first hub 132a and second hub 132b), first connecting tube 126, second connecting tube 128, retrieval device 138 extending within first connecting tube 126, and laser fiber 136 extending within second connecting tube 128, all similar in form and function to access port 30 (including first hub 32a and second hub 32b), first connecting tube 26, second connecting tube 28, laser fiber 36, and retrieval device 38 described above with respect to medical device 10. Figure 6 shows retrieval device 138 extending through the lumen of elongate shaft 120 and extending from the distal end of elongate shaft 120, while the distal end of laser fiber 136 is shown in dashed lines for illustrative purposes only. Thus, it can be appreciated that during a medical procedure, only one or the other of laser fiber 136 or retrieval device 138 (including retrieval wire 139 positioned within a lumen of tubular shaft 137 of retrieval device 138) can occupy the working channel of elongate shaft 120, and the other of laser fiber 136 and retrieval device 138 can be disposed within either first connecting tube 126 or second connecting tube 128 proximal to access port 130. In other cases, laser fiber 136 may occupy a first working lumen of elongate shaft 120, while retrieval device 138, including tubular shaft 137 of retrieval device 138 and retrieval wire 139 extending therethrough, occupies a second working lumen of elongate shaft 120. It may be appreciated that in some examples, each of the first connecting tube 126 and the second connecting tube 128 may be transparent or translucent, which may allow a clinician to see the distal end of the laser fiber 136 and the distal end of the retrieval device 138 positioned within these connecting tubes when they are withdrawn from the working channel of the elongate shaft 120 to allow the other device to occupy the working channel of the elongate shaft 120.It may be desirable for the clinician to be able to visually confirm that the distal end of the retrieval device 138 or the distal end of the laser fiber 136 is positioned in the other of the first connecting tube 126 or the second connecting tube 128, respectively, when advancing either the retrieval device 138 or the laser fiber 136 distally into the working channel of the elongate shaft 120. In addition, Figure 6 illustrates a retrieval wire 139 that includes a retrieval basket 150 and extends through the lumen of the tubular shaft 137 of the retrieval device 138 and is larger than the tubular shaft 137 of the retrieval device 138.

[0093] Additionally, the handle 112 can include a shaft advancing device 134. The shaft advancing device 134 is similar, but not identical, to the shaft advancing device 34 described above. For example, the shaft advancing device 134 can be removably attached (or fixedly attached) to the handle 112 as described above with respect to the shaft advancing device 34. Additionally, although not visible in FIG. 6, the shaft advancing device 134 can include a first thumb wheel (not visible in FIG. 6) that can be utilized to advance / retract the retrieval device 138 and a second thumb wheel (not visible in FIG. 6) that can be utilized to advance / retract the laser fiber 136.

[0094] However, as described in detail below, the shaft advancement device 134 may further include a rotatable cap 186 or other actuation mechanism attached to a housing such as the outer housing 154 (which may be similar in form and function to the outer housing 54 described above), in which case the cap 186 may be used to advance / retract the retrieval wire 139 longitudinally within and relative to the tubular shaft 137 of the retrieval device 138.

[0095] FIG. 7 illustrates the medical device 100 with the rotatable cap 186 removed from the outer housing 154 of the shaft advancement device 134 to reveal a side view (e.g., the outward-facing side) of the outer housing 154. It can be appreciated that the rotatable cap 186 can be coupled to the outer housing 154 through a connection (e.g., a threaded / bolted connection) that allows it to rotate about the same axis as the mandrel 164 (which can be similar in form and function to the mandrel 64 described above). Furthermore, FIG. 7 illustrates that the rotatable cap 186 can include one or more protrusions 188 spaced about its outer surface. It can be appreciated that the protrusions 188 can improve a physician's grip when rotating the rotatable cap 186.

[0096] 7 shows that a lateral surface of outer housing 154 can include channel 163. As shown in FIG. 7, channel 163 can be curved and generally trace around outer housing 154 at a radial distance from mandrel 164. Furthermore, as described in more detail below, channel 163 can be designed to allow a portion of tubular shaft 137 of retrieval device 138 and a portion of retrieval wire 139 to be disposed therein. Specifically, the proximal end of tubular shaft 137 of retrieval device 138 can be fixedly attached within channel 163 (near the upper portion of outer housing 154), while retrieval wire 139 can move freely within (along) channel 163.

[0097] It can further be seen that when fully assembled, rotatable cap 186 can freely rotate about mandrel 164 along the surface of outer housing 154. Furthermore, the detailed view of FIG. 7 shows that proximal end 142 of retrieval wire 139 can protrude from channel 163 and from the lateral surface of outer housing 154 and engage a recess 187 located on the underside of rotatable cap 186. In other words, proximal end 142 of retrieval wire 139 can be fixedly attached (e.g., with an adhesive) to the underside of rotatable cap 186. Other attachment techniques for fixedly attaching proximal end 142 of retrieval wire 139 to rotatable cap 186 are contemplated. For example, proximal end 142 of retrieval wire 139 can be attached to rotatable cap 186 with an adhesive.

[0098] FIG. 8 shows a perspective view of the proximal end region 116 of the medical device 100 described above. FIG. 8 illustrates that the first thumb wheel 156 and the second thumb wheel 157 can be rotatably coupled to a housing, such as the inner housing 162, as discussed above. Additionally, FIG. 8 illustrates the laser fiber 136 extending through an opening 184 into the second connecting tube 128 and the retrieval sheath 138 extending through an opening 186 into the first connecting tube 126. While not all components of the shaft advancement device 134 are shown, it can be appreciated that the operation of the first thumb wheel 156 and the second thumb wheel 157 to drive (e.g., longitudinally move) the retrieval sheath 138 and the laser fiber 136 into the first connecting tube 126 and the second connecting tube 128, respectively, can be similar in form and function to the operation of the first thumb wheel 56 and the second thumb wheel 57 described above. In other words, although not shown in Figure 7, the shaft advancement device 134 can include the arrangement and functionality of the drive wheels 58 / 59 and roller wheels 60 / 61 described above. Additionally, Figure 8 shows the retrieval wire 139 positioned within the channel 163 of the outer housing 154.

[0099] 9-10 illustrate the rotation of rotatable cap 186 relative to outer housing 154 to advance (or retract) retrieval wire 139 within the lumen of tubular shaft 137 of retrieval device 138. The detailed view of FIG. 9 illustrates that proximal end 143 of tubular shaft 137 of retrieval device 138 can be fixedly attached to outer housing 154, e.g., fixedly attached within channel 163 of outer housing 154, as described above. For example, proximal end 143 of tubular shaft 137 of retrieval device 138 can be adhesively glued within channel 163. Thus, proximal end 143 of tubular shaft 137 of retrieval device 138 cannot move relative to outer housing 154. This detailed view further illustrates retrieval wire 139 extending within the lumen of tubular shaft 137 of retrieval device 138, as described above.

[0100] Figure 9 further illustrates retrieval wire 139 extending along the curvature of channel 163. It can be further seen that Figure 9 shows rotatable cap 186 attached to outer housing 154 of handle 112 (for simplicity, rotatable cap 186 is shown as a dashed outline). As mentioned above, in this configuration, it can be seen that proximal end 142 of retrieval wire 139 extends out of the page, thereby being fixedly attached to the underside of rotatable cap 186.

[0101] 10 illustrates rotation of rotatable cap 186 to longitudinally move retrieval wire 139 within and relative to the lumen of tubular shaft 137 of retrieval device 138. It can be appreciated that moving retrieval wire 139 within the lumen of tubular shaft 137 of retrieval device 138 can expand and contract retrieval basket 150 (not shown in FIG. 6 ) attached to the distal end of retrieval wire 139. Thus, a physician can further appreciate that, for example, prior to rotating cap 186 to deploy retrieval basket 150, first thumbwheel 156 can be manipulated to advance or retract retrieval device 138, including tubular shaft 137 and retrieval wire 139 of retrieval device 138, relative to the target site. In other words, as described above, manipulation of first thumb wheel 156 can move retrieval device 138, including its tubular shaft 137 and retrieval wire 139, through the actuation channel of elongate shaft 120 of medical device 100 such that the tubular shaft and retrieval wire move simultaneously (e.g., retrieval wire 139 advances with tubular shaft 137 when retrieval device 138 is manipulated by first thumb wheel 156). However, to actuate retrieval basket 150 (attached to the distal end of retrieval wire 139), the physician can rotate rotatable cap 186 (using the same hand) to move retrieval wire 139 through channel 163 and within the lumen of tubular shaft 137 of retrieval device 138 (rotation of rotatable cap 186 is indicated by arrow 144). In other words, because the proximal end 143 of the tubular shaft 137 of the retrieval device 138 is fixedly attached to the outer housing 154, rotation of the rotatable cap 186 moves only the retrieval wire 139 relative to the outer housing 154 (within the channel 163), and therewith relative to the tubular shaft 137 of the retrieval device 138. In the detailed view of Figure 10, the movement of the retrieval wire 139 relative to the outer housing 154 and the tubular shaft 137 of the retrieval device 138 is illustrated by arrow 145. Additionally, note that Figure 10 illustrates the rotational displacement of the proximal end 142 of the retrieval wire 139 after rotating the rotatable cap 186.

[0102] 11-15 illustrate another exemplary medical device 200. The medical device 200 can be similar in form and function to the medical devices 10 / 100 described above. For example, the medical device 200 can include a handle 212 having a distal end region 214 and a proximal end region 216. The handle 212 can further include an elongate shaft 220 extending distally from the distal end region 214. The elongate shaft 220 can be similar in form and function to the elongate shaft 20 / 120 described above.

[0103] Further, the handle 212 may include an access port 230 (including a first hub 232a and a second hub 232b), which may all be similar in form and function to the access port 30 / 130 (including a first hub 32a / 132a and a second hub 32b / 132b), the first connecting tube 26 / 126, the second connecting tube 28 / 128, the laser fiber 36 / 136, and the retrieval device 38 / 138 described above with respect to the medical device 10 / 100, a first connecting tube 226, a second connecting tube 228, a retrieval device 238 or other elongated medical device extending through the first connecting tube 226 and into the working channel of the elongated shaft 220 of the medical device 200, and a laser fiber 236 extending through the second connecting tube 228 and into the working channel or another working channel of the elongated shaft 220 of the medical device 200. 11 shows retrieval device 238 extending through the lumen of elongate shaft 220 and extending distally from the distal end of elongate shaft 220, while the distal end of laser fiber 236 is shown in dashed lines for illustrative purposes only. Thus, it can be appreciated that during a medical procedure, only one or the other of laser fiber 236 or retrieval device 238 (including retrieval wire 239 positioned within the lumen of tubular shaft 237 of retrieval device 238) can occupy the working channel of elongate shaft 220, and the other of laser fiber 236 and retrieval device 238 can be disposed within either first connecting tube 226 or second connecting tube 228 proximal to access port 230. In other cases, the laser fiber 236 may occupy a first working lumen of the elongate shaft 220, while the retrieval device 238, including its tubular shaft 237 and retrieval wire 239 extending therethrough, occupies a second working lumen of the elongate shaft 220.It can be appreciated that in some examples, each of first connecting tube 226 and second connecting tube 228 may be transparent or translucent, which may allow a clinician to visualize the distal end of laser fiber 236 and retrieval device 238 positioned within these connecting tubes as they are withdrawn from the working channel of elongate shaft 220 to allow the other device to occupy the working channel of elongate shaft 220. It may be desirable for the clinician to visually confirm that the distal end of retrieval device 238 or laser fiber 236 is positioned in the other of first connecting tube 226 or second connecting tube 228, respectively, when either retrieval device 238 or laser fiber 236 is advanced distally into the working channel of elongate shaft 220. In addition, FIG. 11 illustrates a retrieval wire 239 that includes a retrieval basket 250 and extends through the lumen of tubular shaft 237 of retrieval device 238 and is larger than tubular shaft 237 of retrieval device 238.

[0104] 12 illustrates that the handle 212 can include a shaft advancing device 234. The shaft advancing device 234 can be similar to the shaft advancing device 34 described above. For example, the shaft advancing device 234 can be removably (or fixedly) attached to the handle 212, as described above with respect to the shaft advancing device 34 described with respect to the medical device 10.

[0105] FIG. 12 shows a detailed view of the proximal end region 216 of the handle 212. Similar to what was discussed above, FIG. 12 illustrates that the rotatable cap 286 can include one or more protrusions 288 spaced about its outer surface. It can be appreciated that the protrusions 288 can improve a physician's grip when rotating the rotatable cap 286. For purposes of clarity, FIG. 12 illustrates the rotatable cap 286 spaced apart from the handle 212.

[0106] FIG. 12 further illustrates that the shaft advancement device 234 includes an inner housing 262, which can be similar in form and function to the inner housing 62 / 162 described above. However, unlike the inner housing 62 / 162 described above, the inner housing 262 may include only a single thumb wheel 258, or may include first and second thumb wheels as desired. The form and function of the thumb wheel 258 can be similar to the thumb wheels 58 / 158 described above. For example, the thumb wheel 258 can be coupled to the laser fiber 236 through a drive wheel (not visible in FIG. 12). Furthermore, the laser fiber 236 can extend through an opening 284 positioned in the inner housing 262, such that the laser fiber 236 is sandwiched between the drive wheel and a roller wheel (neither the drive wheel nor the roller wheel is visible in FIG. 12). Thus, as described above, the thumb wheel 258 can be used to advance / retract the laser fiber 236 into the second connecting tube 228 and thus through the working channel of the elongated shaft 220 of the medical device 200 in a manner similar to that described above with respect to the medical device 10 / 100.

[0107] However, shaft advancing device 234 may differ from shaft advancing device 34 / 134 described above in that advancement / retraction of retrieval device 238 and / or its retrieval wire 239 may be achieved through a cooperative relationship between rotating disc 265 and rotatable cap 286. It should be noted that in some instances, rotating disc 265 may be positioned on shaft advancing device 234 in the same relative location as first thumb wheel 56 / 156 was positioned in medical device 10 / 100 described above. In other words, rotating disc 265, which may also be considered a thumb wheel of shaft advancing device 234, may be considered to replace first thumb wheel 56 / 156 in medical device 10 / 100 described above.

[0108] 12 illustrates that the rotating disk 265 can be coupled to the inner housing 262 by the passage of the axle 264 of the inner housing 262 through an opening in the rotating disk 265. FIG. 12 illustrates that the axle 264 of the inner housing 262 can be positioned approximately within a central region of the inner housing 262. It can further be appreciated that the rotating disk 265 can be rotated about the axle 264 by operation of the thumb lever 253. For example, a physician can appreciate that they can use their thumb to operate the lever 253 to rotate the rotating disk 265 about the axle 264.

[0109] FIG. 12 further illustrates that the shaft advancement device 234 can include a locking mechanism that locks the position of the retrieval device relative to the elongate shaft 220 of the medical device in one of a plurality of positions. For example, the inner housing 262 can include a plurality of teeth 251 positioned adjacent a lever 253 along its outer periphery. It can further be seen that the lever 253 can include a protrusion 282 that engages the teeth 251 and locks the rotating disc 265 in a fixed position when seated between two adjacent teeth 251. When in the locked position, the rotating disc 265 can be prevented from rotating in a clockwise and / or counterclockwise direction. For example, in the example shown in FIG. 12 , the thumb lever 253 can be utilized to rotate the rotating disc 265 about the axle 264. For example, a force applied to the thumb lever 253 by a user's thumb (or other finger) can bend the thumb lever 253 and disengage the protrusion 282 from between the adjacent teeth 251, thereby allowing the rotating disc 265 to rotate. However, when the rotating disk 265 stops rotating and the force is removed, the protrusion 282 may return toward the stem 264 and engage a flat rear portion of a given tooth 251, thereby preventing the rotating disk 265 from freely rotating in a clockwise direction. It can be appreciated that to rotate the rotating disk 265 in a clockwise direction, the physician can depress the thumb lever 253 to bend the protrusion 282 away from the stem 264, thereby allowing the protrusion 282 to pass over the top of the tooth 251 as the rotating disk 265 rotates clockwise. As mentioned above, a locking mechanism is used to secure the longitudinal position of the retrieval device 238, which can prevent distal movement of the tubular shaft 237 of the retrieval device 238 when the retrieval wire 239 is advanced or retracted by rotation of the rotating cap 286 as discussed herein.

[0110] In the illustrated embodiment, to prevent inadvertent distal advancement of the retrieval device 238, the sides of the teeth 251 are shaped such that the protrusions 282 must be actively disengaged by depressing the thumb lever 253 to rotate the rotating disk 265 in a clockwise direction. However, due to the acute angle of the tooth sides, the protrusions 282 can slide along the angled sides of the teeth, allowing counterclockwise rotation. In another embodiment, to prevent inadvertent proximal withdrawal of the retrieval device 238, the sides of the teeth 251 can be reversed such that the protrusions 282 must be actively disengaged by depressing the thumb lever 253 to rotate the rotating disk 265 in a counterclockwise direction. However, due to the acute angle of the tooth sides, the protrusions 282 can slide along the angled sides of the teeth, allowing clockwise rotation. In another embodiment, the teeth 251 may include a "V" shape that can function to prevent both clockwise and counterclockwise rotation of the rotating disc 265 when a protrusion is positioned within one of the grooves of the teeth 251.

[0111] FIG. 12 further illustrates that the proximal end region of first connecting tube 226 can be fixedly attached to a housing, such as inner housing 262. For example, the detailed view in the upper left portion of FIG. 12 shows that the proximal end of first connecting tube 226 can be fixedly attached to inner housing 262 by glue or other attachment method (e.g., press fit). Furthermore, the detailed view in the upper left portion of FIG. 12 shows retrieval device 238 extending within the lumen of first connecting tube 226. This same detailed view also shows retrieval wire 239 positioned within the lumen of tubular shaft 237 of retrieval device 238 (and, by extension, positioned within the lumen of first connecting tube 226). Because first connecting tube 226 is fixedly attached to inner housing 262, it can be appreciated that retrieval device 238, including both tubular shaft 237 and retrieval wire 239 of retrieval device 238, can move within itself relative to first connecting tube 226.

[0112] FIG. 12 further illustrates that inner housing 262 can include a channel 263 that is curved and generally follows the circumference of rotating disc 265 at a radial distance from mandrel 264. Additionally, FIG. 12 shows that a portion of both tubular shaft 237 of retrieval device 238 and retrieval wire 239 can be disposed within channel 263. In particular, the detail view in the lower right corner of FIG. 12 shows where, within channel 263, a proximal end region of tubular shaft 237 of retrieval device 238 can be fixedly attached to rotating disc 265. That is, it can be appreciated that rotation of rotating disc 265 (as described above) can advance or retract tubular shaft 237 of retrieval device 238, and retrieval wire 239 therein, relative to first connecting tube 226.

[0113] Additionally, the detailed view in the upper right corner of FIG. 12 shows the retrieval wire 239 positioned within the channel 263 of the rotating disc 265. The retrieval wire 239 may not be fixedly attached to the rotating disc 265. Rather than being fixedly attached to the rotating disc 265, the detailed view in the upper right corner of FIG. 12 shows that the proximal end of the retrieval wire 239 can be bent outward to engage and fixedly attach to a recess 287 positioned along the underside of the rotating cap 286. Note that the retrieval wire 239 can otherwise be fixedly attached to the rotating cap 286. Similar to the function of the rotating cap 186 described above with respect to the medical device 100, rotation of the rotating cap 286 can move the retrieval wire 239 longitudinally within the channel 263 of the rotating disc 265 and through the lumen of the tubular shaft 237 of the retrieval device 238.

[0114] However, it can be further appreciated that the rotating cap 286 can be engaged with the rotating disk 265 such that the rotating cap 286 can rotate with the rotating disk 265 when the rotating disk 265 is rotated (e.g., by the thumb lever 253). In some examples, the back side of the rotating cap 286 can include a protrusion (not visible in FIG. 12 ) that extends toward the rotating disk 265 and abuts into a channel in which the spring 255 is positioned. The spring 255 can contact and bias the protrusion. Thus, the rotating cap 286 can "entrain" the rotating disk 265 when the rotating disk 265 is rotated such that there is no relative rotation between the rotating cap 286 and the rotating disk 265 when the rotating disk 265 is rotated.

[0115] It can further be appreciated that when the rotating disk 265 is rotated (and the rotating cap 286 rotates with the rotating disk 265), both the tubular shaft 237 of the retrieval device 238 and the retrieval wire 239 will move together within the first connecting tube 226 and / or through the working channel of the elongate shaft 220. In other words, when the rotating disk 265 is rotated, the rotating disk 265 moves the tubular shaft 237 of the retrieval device 238, and at the same time, the rotating cap 286 (seated on top of the rotating disk 265) will rotate with the rotating disk 265, moving the retrieval wire 239 at the same speed (displacement) as the tubular shaft 237 of the retrieval device 238.

[0116] However, it can be appreciated that the rotating cap 286 can be rotated relative to the rotating disk 265 (and by extension, the inner housing 262) after the rotation of the rotating disk 265 is stopped and the protrusions 282 engage the teeth 251 (thereby locking the rotating disk 265 in place relative to the inner housing 262). Rotation of the rotating cap 286 relative to the rotating disk 265 can advance (or retract) the retrieval wire 239 relative to the tubular shaft 237 of the retrieval device 238, and thus advance the retrieval basket 250 relative to the tubular shaft 237 of the retrieval device 238.

[0117] As discussed above, FIG. 12 shows that handle 212 can include spring 255 positioned within an invaginated channel on rotating disk 265. As described in more detail below, one end of spring 255 can be coupled to the underside of rotating cap 265 (e.g., a connection technique similar to that used to connect the proximal end of retrieval wire 239 to the underside of rotating cap 286 can be used to connect the distal end of spring 255 to the underside of rotating cap 286). Thus, spring 255 can be designed to bias rotating cap 286 to rotate counterclockwise after rotating cap 286 clockwise to release. Thus, spring 255 can be implemented to bias rotating cap 286, and thus retrieval wire 239, to a retracted configuration in which retrieval basket 250 is collapsed. By rotating rotating cap 286 clockwise to overcome the force of spring 255, retrieval basket 250 is deployed (e.g., expanded).

[0118] 13-15 illustrate the cooperative actuation of the rotating disk 265 and rotating cap 286 to advance / retract or otherwise manipulate the retrieval device 238. FIG. 13 illustrates a handle configuration in which both the tubular shaft 237 and retrieval wire 239 of the retrieval device 238 can be positioned within the working channel of the elongate shaft 220 and disposed just proximal to the distal end of the elongate shaft 220. For purposes of clarity, the rotating cap 286 is shown removed from the handle 212. However, it should be understood that in FIGS. 13-15, the rotating cap 286 is considered to be positioned on top of the rotating disk 265, as described above. Additionally, FIG. 13 illustrates a position where the rotating disk 265 has not been rotated clockwise and the retrieval wire 239 has not been moved relative to the tubular shaft 237 of the retrieval device 238.

[0119] FIG. 14 illustrates the simultaneous rotation of the retrieval disc 265 and the rotatable cap 286. As described above, rotation of the rotatable disc 265 can be achieved by operation of the thumb lever 253 on the plurality of teeth 251. FIG. 14 illustrates that in some examples, rotation of the rotatable disc 265 can be limited between a first stop 259 and a second stop 254. For example, the rotatable disc 265 can include a protrusion 261 that engages the first stop 259 in a fully retracted position. The protrusion 261 can enter into engagement with the second stop 254 when the rotatable disc 265 is rotated clockwise to its maximum clockwise or fully extended position. This engagement prevents further clockwise rotation of the rotatable disc 265, and therefore further distal advancement of the tubular shaft 237 of the retrieval device 238 out of or otherwise relative to the distal end of the elongated shaft 220. 14 illustrates the rotation of rotating disk 265 with arrow 270 and the rotation of the rotating cap (occurring simultaneously with rotating disk 265) with arrow 283. As discussed above, rotation of rotating disk 265 can move both tubular shaft 237 and retrieval wire 239 of retrieval device 238 out the distal end of elongate shaft 220. FIG. 14 further illustrates that protrusions 282 engage teeth 252, thus preventing rotating disk 265 from rotating relative to inner housing 262.

[0120] FIG. 15 illustrates independent rotation of rotatable cap 286 relative to rotatable disk 265 to move retrieval wire 239 relative to tubular shaft 237 of retrieval device 238. As shown in FIG. 15 , rotatable cap 286 can be rotated relative to rotatable disk 265 (rotation of rotatable cap 286 is indicated by arrow 267), which moves distal end 242 of retrieval wire 239 within channel 263 (note that the position of distal end 242 of retrieval wire 239 within channel 263 in FIG. 14 indicates movement of wire 239 within channel 263 compared to the position in FIG. 15 ). Additionally, because rotatable disk 265 is fixed in FIG. 15 , tubular shaft 237 of retrieval device 238 remains stationary, while retrieval wire 239 is moved within the lumen of tubular shaft 237 of retrieval device 238. It can be appreciated that this movement can deploy (e.g., expand) basket 250 at the distal end of retrieval device 238. 15 further illustrates spring 255 being compressed when rotating cap 286 is rotated, such that after rotating cap 286 is released, expansion of spring 255 causes rotating cap 286 to rotate counterclockwise, thereby moving retrieval wire 239 within channel 263 and collapsing retrieval basket 250.

[0121] 16-17 show another exemplary medical device 300. Medical device 300 can be similar in form and function to medical device 200 described above. For example, medical device 300 can include a handle 312 having an elongated shaft 320 extending distally from the distal end of handle 312. Elongated shaft 320 can be similar in form and function to elongated shaft 20 described above.

[0122] Further, the handle 312 may include a first connecting tube 326, a second connecting tube 328, which may all be similar in form and function to the first connecting tube 26 / 126 / 226, the second connecting tube 28 / 128 / 228, the retrieval device 38 / 138 / 238 extending through the first connecting tube 26 / 126 / 226, and the laser fiber 36 / 136 / 236 extending through the second connecting tube 28 / 128 / 228 described above with respect to the medical device 10 / 100 / 200, a retrieval device 338 or other elongate medical device extending through the first connecting tube 326 and into the working channel of the elongate shaft 320 of the medical device 300, and a laser fiber 336 extending through the second connecting tube 328 and into this or another working channel of the elongate shaft 320 of the medical device 300.

[0123] 16 illustrates that the handle 312 can include a shaft advancing device 334. The shaft advancing device 334 can be similar to the shaft advancing device 234 described above. For example, the shaft advancing device 334 can be removably (or fixedly) attached to the handle 312 as described above with respect to the shaft advancing device 234 described with respect to the medical device 200. Furthermore, the actuation of the shaft advancing device 334 can be similar in function to the shaft advancing device 234 described above. However, as shown in FIG. 16 , the shaft advancing device 334 may not include the teeth 251 or thumb lever 253 (including the protrusion 282) described above with respect to the shaft advancing device 234. Instead, the shaft advancing device 334 can include an elongated tubular shaft 337 and a retrieval wire 339 extending therethrough that are wound around a rotating disc 365. Thus, it can be appreciated that when the rotating disk 365 is rotated (e.g., in a clockwise direction), the retrieval device 338 can be advanced within the first connecting tube 326 and / or within the working channel extending through the elongated shaft 320.

[0124] In some examples, the retrieval device 338 can be wrapped around a shelf (e.g., a rim, lip, ledge, etc.) positioned on the rotating disk 365. However, in other examples, the retrieval device 338 can be wrapped within a channel that extends into the face of the rotating disk 365, for example.

[0125] 16 illustrates that the proximal end of retrieval wire 339 can extend from the proximal end of tubular shaft 337 of retrieval device 338 and can be coupled to the back side of rotatable cap 386 in a manner similar to that described above with respect to medical device 200. Similarly, FIG. 16 illustrates that shaft advancement device 334 can include a spring 355 that abuts within a channel positioned on rotatable disk 365. Similar to that described above with respect to medical device 200, rotation of rotatable cap 386 can advance retrieval wire 339 relative to tubular shaft 337 of retrieval device 338, thereby deploying (e.g., expanding) an end effector (e.g., a retrieval basket) at the distal end of retrieval device 338. However, as described above, when rotatable cap 386 is released, spring 355 expands, thereby rotating rotatable cap 386 counterclockwise and retracting retrieval wire 339 proximally relative to tubular member 337 of retrieval sheath 338, thereby contracting the retrieval basket. In other words, as described above with respect to medical device 200, spring 355 can function to bias a retrieval basket or other end effector positioned on the distal end of retrieval device 338 toward a closed or retracted configuration.

[0126] FIG. 17 is a perspective view of the medical device 300 shown in FIG. 16 . FIG. 17 shows that the shaft advancement device 334 includes an inner housing 362, which can be similar in form and function to the inner housing 62 / 162 / 262 described above. The inner housing 362 can include a single thumb wheel 358, or can include first and second thumb wheels, as desired. The thumb wheel 358 can be similar in form and function to the thumb wheels 58 / 158 / 258 described above. For example, the thumb wheel 358 can be coupled to the laser fiber 336 through a drive wheel (not visible in FIG. 17 ), such that the laser fiber 336 is sandwiched between the drive wheel and a roller wheel (neither the drive wheel nor the roller wheel are visible in FIG. 17 ). Thus, as described above, the thumb wheel 358 can be utilized to advance / retract the laser fiber 336 through the second connecting shaft 328 in a manner similar to that described above with respect to the medical device 10 / 100 / 200.

[0127] 17 illustrates that retrieval device 338 (including the combination of tubular shaft 337 of retrieval device 338 and retrieval wire 339) can be wrapped around rotating disc 365. It can further be appreciated that in an assembled configuration, tubular shaft 337 of retrieval device 338 can be positioned between rotating cap 386 and rotating disc 365. Rotating cap 386 and rotating disc 365 can be threaded onto threaded mandrel 364 such that the additional rotating cap 386 and rotating disc 365 together can be spaced a distance "X" from the inner housing.

[0128] It can be appreciated that in operation, the clinician can rotate the rotating disc 365 and rotating cap 386 in a clockwise direction, thereby advancing the retrieval device 338 through the working channel of the elongated shaft 320. When the rotating disc 365 and rotating cap 386 are threaded onto the threaded mandrel 364, clockwise rotation of the rotating disc 365 and rotating cap 386 will move both the rotating disc 365 and rotating cap 386 toward the lateral surface of the inner housing 362. It can be appreciated that the rotating disc 365 and rotating cap 386 can be rotated clockwise until the protrusion 361 positioned on the rotating disc 365 engages the positive stop 354 on the inner housing 362. At this point of engagement, any further clockwise rotation of the rotating disc 365 is prevented (which also prevents further distal movement of the tubular shaft of the retrieval device 338). However, as described above, the rotating cap 386 can still be rotated clockwise (thereby compressing the spring 355) to advance the retrieval wire 339 distally relative to the distal end of the tubular shaft 337 of the retrieval device 338, thereby opening or expanding the end effector. Furthermore, releasing the cap 386 causes the spring 355 to expand, allowing the cap 386 to be rotated counterclockwise, which retracts the retrieval wire 339 proximally relative to the distal end of the tubular shaft 337 of the retrieval device 338, thereby closing or retracting the end effector. This actuation mechanism is similar to that described above with respect to the rotating cap 286 and spring 255 of the medical device 200.

[0129] Another embodiment of a shaft advancing device 434 is shown in Figures 18A and 18B. As with the other shaft advancing devices 34 / 134 / 234 / 334 disclosed herein, the shaft advancing device 434 can be removably or fixedly attached to the handle of a medical device. In many aspects, the operation of the shaft advancing device 434 can be similar to the other shaft advancing devices 34 / 134 / 234 / 334 with some modifications. Thus, the features of the shaft advancing device 434 can be physically incorporated into the other shaft advancing devices 34 / 134 / 234 / 334 described above, as desired.

[0130] 18A , the shaft advancing device 434 can include a housing 462 that is attachable (removably or fixedly) to the handle of a medical device, such as the other medical devices described above. The shaft advancing device 434 can include a thumb wheel 456 coupled to the housing 462 by the threading of a stem 464 through an opening in the thumb wheel 456. The thumb wheel 456 is thus rotatably coupled to the housing 462 through the stem 464 so as to be permitted to rotate about the axis of the stem 464. Similar to the other thumb wheels described above, the thumb wheel 456 can include a band of material 470 extending circumferentially around its circumference. The material used to construct the band of material 470 can generally be designed to include a material that allows a user to grip the thumb wheel 456 when manipulating it. For example, the band of material 470 can include rubber, silicone, nitrile butadiene rubber, a thermoplastic elastomer, neoprene, other elastic materials, or similar materials.

[0131] It can be appreciated that when assembled, thumb wheel 456 can be rotated in either a clockwise or counterclockwise direction about axle 464. Additionally, as described in more detail below, a physician can manually rotate thumb wheel 456 using the thumb (or another finger) of their hand gripping the handle of the medical device. Unlike the embodiments described above, shaft advancement device 434 may not include a separate drive wheel, but instead may include only thumb wheel 456 and roller wheel 460, which also serve as a drive wheel.

[0132] The roller wheel 460 can be coupled to the housing 462 via an axle 474 extending from a face of the housing 462. It can be appreciated that the roller wheel 460 can rotate in a clockwise or counterclockwise direction about the axis of the axle 474. Furthermore, FIG. 18A shows that the roller wheel 460 can include a band of material 449 extending circumferentially around its circumference. The band of material 449 can be similar in form and function to the band of material 470 described above. The circumferential surface of the thumb wheel 456 can be positioned adjacent to the circumferential surface of the roller wheel 460. For example, the roller wheel 460 can be in contact with the thumb wheel 456 (e.g., the band of material 470 of the thumb wheel 456 can directly contact the band of material 449 of the roller wheel 460), or a small gap may remain therebetween suitable for placement of the elongated shaft 438 of a medical device (e.g., a retrieval device or a laser fiber) therebetween.

[0133] FIG. 18B illustrates a mechanism for advancing (or retracting) the elongate shaft 438 into and out of a working channel of the elongate shaft of a medical device (e.g., an endoscope) by manipulating the thumb wheel 456. Rotation of the thumb wheel 456 causes rotation of the roller wheel 460 in the opposite direction. For example, as shown in FIG. 18B, counterclockwise rotation of the thumb wheel 456 (as viewed from the outer surface of the thumb wheel 456) causes clockwise rotation of the roller wheel 460. When the elongate shaft 438 of the medical device is positioned therebetween, counterclockwise rotation of the thumb wheel 456, as indicated by arrow A, advances the elongate shaft 438 distally, as indicated by arrow B. Similarly, clockwise rotation of the thumb wheel 456 retracts the elongate shaft 438 proximally.

[0134] It can be appreciated that the function of thumb wheel 456 to move elongated shaft 438 relative to the first connecting tube (described above) and relative to the working channel of the elongated shaft of the endoscope (described above) is achieved by a compressive force exerted on elongated shaft 438 when elongated shaft 438 is sandwiched between thumb wheel 456 and roller wheel 460. It can further be appreciated that thumb wheel 456 and roller wheel 460 must be spaced apart from one another to allow shaft advancement device 434 to sufficiently advance elongated shaft 438 without sliding within the first connecting tube and the working channel of the elongated shaft of the endoscope (described above), while also providing comfortable tactile feedback from thumb wheel 456 to the user. In some examples, roller wheel 460 can be spring-mounted such that the spacing between thumb wheel 456 and roller wheel 460 is adjustable for elongated shafts of medical devices having various outer diameters.

[0135] As mentioned above, any of the shaft advancement devices disclosed herein can be configured to have only a thumb wheel and roller wheel as described above with respect to Figures 18A-18B.

[0136] Materials that can be used for the various components of the embodiments disclosed herein can include those commonly associated with medical devices. For purposes of simplicity, the following discussion will refer to ureteroscope instruments and other components of a ureteroscope. However, this reference is not intended to limit the devices and methods described herein, as this discussion can apply to other similar tubular members and / or tubular members or components of the devices disclosed herein.

[0137] The medical device 10 and / or its components can be fabricated from metals, metal alloys, polymers (some examples of which are disclosed below), metal-polymer composites, ceramics, and combinations thereof, or other suitable materials. Some examples of suitable polymers include polytetrafluoroethylene (PTFE), ethylene tetrafluoroethylene (ETFE), fluorinated ethylene propylene (FEP), polyoxymethylene (POM, e.g., DELRIN® available from DuPont), polyether block esters, polyurethanes (e.g., polyurethane 85A), polypropylene (PP), polyvinyl chloride (PVC), polyether-esters (e.g., ARNITEL® available from DSM Engineering Plastics), ether- or ester-based copolymers (e.g., butylene / poly(alkylene ether) phthalates and / or other polyester elastomers, e.g., HYTREL® available from DuPont), polyamides (e.g., DURETHAN® or Elf® available from Bayer), and the like. CRISTAMID® available from Atochem), elastomeric polyamides, block polyamide / ethers, polyether block amides (PEBA, e.g., available under the trade name PEBAX®), ethylene vinyl acetate copolymer (EVA), silicone, polyethylene (PE), Marlex® high density polyethylene, Marlex® low density polyethylene, linear low density polyethylene (e.g., REXELL®), polyester, polybutylene terephthalate (PBT), polyethylene terephthalate (PET), polytrimethylene terephthalate, polyethylene naphthalate (PEN), polyether ether ketone (PEEK), polyimide (PI), polyetherimide (PEI), polyphenylene sulfide (PPS), polyphenylene oxide (PPO), polyparaphenylene terephthalamide (e.g., KEVLAR®), polysulfone, nylon, nylon 12 (EMS AmericanThe sheath may comprise any suitable material, such as GRILAMID® available from Grillon, perfluoro(propyl vinyl ether) (PFA), ethylene vinyl alcohol, polyolefin, polystyrene, epoxy, polyvinylidene chloride (PVdC), poly(styrene-b-isobutylene-b-styrene) (e.g., SIBS and / or SIBS 50A), polycarbonate, ionomer, biocompatible polymer, other suitable material, or mixtures, combinations, copolymers, and polymer / metal composites thereof. In some embodiments, the sheath may be compounded with a liquid crystal polymer (LCP). For example, the mixture may contain up to about 6 percent LCP.

[0138] Some examples of suitable metals and metal alloys include stainless steels such as 304V, 304L, and 316LV stainless steel, mild steel, nickel-titanium alloys such as linear elastic nitinol and / or superelastic nitinol, other nickel alloys, for example, nickel-chromium-molybdenum alloys (e.g., UNS: N06625 such as INCONEL® 625, UNS: N06022 such as HASTELLOY® C-22®, HASTELLOY® C276®, and the like). trademark), and other HASTELLOY® alloys, etc.), nickel-copper alloys (e.g., UNS:N10276, such as MONEL® 400, NICKELVAC® 400, NICORROS® 400, etc.), nickel-cobalt-chromium-molybdenum alloys (e.g., UNS:R30035, such as MP35-N®), nickel-molybdenum alloys (e.g., HASTELLOY® ALLOY B2®), other nickel-chromium alloys, other nickel-molybdenum alloys, other nickel-cobalt alloys, other nickel-iron alloys, other nickel-copper alloys, and other nickel-tungsten or tungsten alloys, cobalt-chromium-molybdenum alloys (e.g., UNS:R30003, such as ELGILOY® and PHYNOX®), platinum-rich stainless steels, titanium, and combinations thereof, or any other suitable material.

[0139] As suggested herein, within the family of commercially available nickel-titanium or Nitinol alloys, there is a classification termed "linear elastic" or "non-superelastic" that may have similar chemistry to conventional shape memory and superelastic varieties but may exhibit distinctly different advantageous mechanical properties. Linear elastic and / or non-superelastic Nitinol can be distinguished from superelastic Nitinol in that its stress / strain curve does not exhibit a substantial "superelastic plateau" or "flag region" as exhibited by superelastic Nitinol. Instead, in linear elastic and / or non-superelastic Nitinol, as recoverable strain increases, stress increases substantially linearly until plastic deformation begins, or with a partially, but not necessarily entirely, linear relationship or a more linear relationship than the superelastic plateau and / or flag region observed in superelastic Nitinol. Accordingly, for purposes of this disclosure, linear elastic and / or non-superelastic Nitinol may be referred to as "substantially" linear elastic and / or non-superelastic Nitinol.

[0140] In some cases, linear elastic and / or non-superelastic nitinol can be distinguished from superelastic nitinol in that linear elastic and / or non-superelastic nitinol can accommodate strains of up to about 2-5% while remaining substantially elastic (e.g., before plastic deformation), while superelastic nitinol can accommodate strains of up to about 8% before plastic deformation. Both of these materials can be distinguished (and also based on their composition) from other linear elastic materials, such as stainless steel, which can only accommodate strains of about 0.2 to 0.44 percent before plastic deformation.

[0141] In some embodiments, linear elastic and / or non-superelastic nickel-titanium alloys do not exhibit any martensite / austenite phase changes detectable by differential scanning calorimetry (DSC) and dynamic metal thermal analysis (DMTA) over a wide temperature range. For example, in some embodiments, there may be no martensite / austenite phase changes detectable by DSC and DMTA analysis within about −60 degrees Celsius (°C) to about 120°C in linear elastic and / or non-superelastic nickel-titanium alloys. Thus, the mechanical bending properties of such materials may be substantially unaffected by temperature over this very wide temperature range. In some embodiments, the mechanical bending properties of linear elastic and / or non-superelastic nickel-titanium alloys at ambient or room temperature are substantially the same as those at body temperature, e.g., in that they do not exhibit a superelastic plateau and / or flag region. In other words, linear elastic and / or non-superelastic nickel-titanium alloys maintain their linear elastic and / or non-superelastic attributes and / or properties over a wide temperature range.

[0142] In some embodiments, the linear elastic and / or non-superelastic nickel-titanium alloy can be about 50 weight percent to about 60 weight percent nickel, with the remainder essentially titanium. In some embodiments, the composition can be about 54 weight percent to 57 weight percent nickel. One example of a suitable nickel-titanium alloy is FHP-NT alloy, available from Furukawa Techno Material Co., Japan. Some examples of nickel-titanium alloys are disclosed in U.S. Patent Nos. 5,238,004 and 6,508,803, which are incorporated herein by reference. Other suitable materials can include ULTANIUM® (available from Neo-Metrics) and GUM METAL® (available from Toyota). In some other embodiments, a superelastic alloy, such as superelastic nitinol, can be used to achieve desired properties.

[0143] In at least some embodiments, other portions of the ureteroscope instrument and / or assembly may be doped with, fabricated from, or otherwise include a radiopaque material. A radiopaque material is understood to be a material capable of producing a relatively bright image on a fluoroscopy screen or with another imaging technique during a medical procedure. This relatively bright image assists the user of the assembly in determining its location. Some examples of radiopaque materials include, but are not limited to, gold, platinum, palladium, tantalum, tungsten alloys, and polymeric materials filled with radiopaque fillers. Additionally, other radiopaque marker bands and / or coils may be incorporated into the assembly design to achieve the same results.

[0144] In some embodiments, a degree of magnetic resonance imaging (MRI) compatibility is provided within the examples. For example, the ureteroscope instrument, or portions thereof, can be made of a material that does not substantially distort the image and create substantial artifacts (e.g., gaps in the image). For example, certain ferromagnetic materials may not be suitable because they may create artifacts in MRI images. The ureteroscope instrument, or portions thereof, can also be made of a material that can be imaged by an MRI machine. Some materials that exhibit these attributes include, for example, tungsten, cobalt-chromium-molybdenum alloys (e.g., UNS:R30003, such as ELGILOY® and PHYNOX®), nickel-cobalt-chromium-molybdenum alloys (e.g., UNS:R30035, such as MP35-N®), and nitinol, among others.

[0145] It should be understood that the present disclosure is, in many respects, merely illustrative. Changes may be made in details, particularly in matters of shape, size, and arrangement of steps, without exceeding the scope of the present disclosure. This may include, to the extent appropriate, the use of any of the features of one illustrative embodiment used in other embodiments. The scope of the present disclosure is, of course, defined by the language in which the appended claims are expressed. [Explanation of symbols]

[0146] 10 Medical Devices 12 Handle 34 Shaft advancement device 36 Laser Fiber 50 Collection Basket

Claims

1. 1. An actuation mechanism for an endoscope, comprising: a housing configured to be attached to a handle of an endoscope; a first thumb wheel coupled to the housing; a first connecting tube having a proximal end coupled to the housing and a distal end configured to connect to an access port in a handle of the endoscope, the access port communicating with a working channel of the endoscope; and Equipped with rotation of the first thumb wheel causes longitudinal movement of a first elongated medical device through the first connecting tube and the working channel of the endoscope; the housing includes a stem configured to be inserted into a slot formed in an exterior surface of the handle of the endoscope, the first thumb wheel being coaxially disposed with the stem.

2. a first drive wheel coupled to the housing, the first thumb wheel engaging the first drive wheel; 2. The actuation mechanism of claim 1, wherein rotation of the first thumb wheel causes rotation of the first drive wheel.

3. a first roller wheel coupled to the housing; an outer circumferential surface of the first roller wheel positioned adjacent to an outer circumferential surface of the first drive wheel such that the first elongated medical device can be positioned between the outer circumferential surface of the first roller wheel and the outer circumferential surface of the first drive wheel; 3. The actuation mechanism of claim 2, wherein rotation of the first thumb wheel causes rotation of the first drive wheel to move the first elongated medical device through the working channel of the endoscope.

4. 4. The actuation mechanism of claim 3, wherein the first roller wheel and the first drive wheel are configured to cooperatively exert a compressive force on the first elongated medical device to frictionally engage the first elongated medical device therebetween.

5. the first thumb wheel includes a circumferential surface; 5. The actuation mechanism of claim 4, wherein a band of material extends around each of the first thumb wheel, the first drive wheel, and the first roller wheel.

6. a second thumb wheel coupled to the housing; a second drive wheel coupled to the housing; and a second roller wheel coupled to the housing; the second thumb wheel engages the second drive wheel; 6. The actuation mechanism of any one of claims 3 to 5, wherein rotation of the second thumb wheel causes longitudinal movement of a second elongated medical device through a working channel of the endoscope.

7. a first roller wheel coupled to the housing; an outer circumferential surface of the first roller wheel positioned adjacent to an outer circumferential surface of the first thumb wheel such that the first elongated medical device can be positioned between the outer circumferential surface of the first roller wheel and the outer circumferential surface of the first thumb wheel; 10. The actuation mechanism of claim 1, wherein rotation of the first thumb wheel causes rotation of the first roller wheel to move the first elongated medical device through the working channel of the endoscope.

8. the housing includes a channel extending from an outer surface of the housing into a portion of a wall of the housing; the channel is configured to receive a proximal end of a tubular member of the first elongate medical device; the proximal end of the tubular member of the first elongate medical device is fixedly attached to the channel; The actuation mechanism of claim 1 , wherein the channel is configured to receive an elongate member of the first elongate medical device extending within a lumen of the tubular member of the first elongate medical device.

9. a rotating cap coupled to the housing; a proximal end of the elongate member attached to the rotatable cap; The actuation mechanism of claim 8, wherein rotation of the rotating cap moves the elongate member within the lumen of the tubular member of the first elongate medical device.

10. An endoscopic medical device, comprising: a handle having a proximal end region and a distal end region; an elongate shaft coupled to and extending distally from the distal end region of the handle, the elongate shaft including a lumen defining a working channel extending therethrough from the distal end region of the elongate shaft to an access port; an actuation assembly coupled to the proximal end region of the handle; Equipped with The actuation assembly includes: Housing and a first thumb wheel coupled to the housing; a second thumb wheel coupled to the housing; and a first connecting tube having a proximal end coupled to the housing and a distal end coupled to the access port; a second connecting tube having a proximal end coupled to the housing and a distal end coupled to the access port; Including, rotation of the first thumb wheel moves a first elongated medical device through the first connecting tube and the working channel of the elongated shaft; rotation of the second thumb wheel moves a second medical device through the second connecting tube and the working channel of the elongate shaft; The housing includes a stem configured to be inserted into a slot formed in an outer surface of the handle, and the first thumb wheel and the second thumb wheel are arranged coaxially with the stem.

11. the actuation assembly further includes a first drive wheel and a first roller wheel coupled to the housing, the first drive wheel configured to be rotated by the first thumb wheel; the actuation assembly further includes a second drive wheel and a second roller wheel coupled to the housing, the second drive wheel configured to be rotated by the second thumb wheel; the first drive wheel and the first roller wheel are configured to cooperatively exert a force on a first medical device positioned therebetween; The endoscopic medical device of claim 10, wherein the second drive wheel and the second roller wheel are configured to cooperatively exert a force on the second medical device positioned therebetween.

12. rotation of the first thumb wheel rotates the first drive wheel and the first roller wheel in counter-rotational directions to move the first elongated medical device through the elongated shaft; The endoscopic medical device of claim 11, wherein rotation of the second thumb wheel rotates the second drive wheel and the second roller wheel in opposite rotational directions to move a second elongated medical device through the elongated shaft.

13. 1. A working assembly for an endoscope, comprising: a housing configured to be attached to a handle of an endoscope; a thumb wheel coupled to the housing; a connecting tube having a proximal end coupled to the housing and a distal end configured to connect with an access port in a handle of the endoscope, wherein rotation of the thumb wheel causes movement of a first elongated shaft within the connecting tube and within a working channel of the endoscope; and a rotating cap coupled to the housing, the rotating cap coupled to a second elongated shaft extending within a lumen of the first elongated shaft; Equipped with rotation of the rotatable cap causes translation of the second elongate shaft within the lumen of the first elongate shaft; 1. An actuation assembly comprising: a housing including a stem configured to be inserted into a slot formed in an exterior surface of the handle of the endoscope; and a thumb wheel disposed coaxially with the stem.

14. 14. The actuation assembly of claim 13, wherein the rotation of the thumb wheel moves both the first elongated shaft and the second elongated shaft together within the working channel of the endoscope.

15. 15. An actuation assembly according to claim 13 or claim 14, further comprising a drive wheel having a circumferential surface in contact with both the thumb wheel and the first elongated shaft.

Images