Medical systems, devices, and related methods

Abstract

In one example, the medical device includes a handle having a proximal portion and a distal portion, the proximal portion pivoting relative to the distal portion. The medical device also includes an insert coupled to the distal portion of the handle and configured to be positioned within a body lumen, and an articulation wire extending from the handle and through the insert portion. By pivoting the proximal portion of the handle relative to the distal portion of the handle, the articulation wire moves relative to the insert portion, causing the distal portion of the insert portion to bend.

Description

[Technical Field]

[0001] FIELD OF THE INVENTION The present invention relates to medical systems, devices, and methods. For example, the present invention relates to medical systems, devices, and methods for operating medical devices such as sphincterotomes. [Background technology]

[0002] Medical devices, such as endoscopes or other suitable insertable devices, are used in a variety of diagnostic and surgical procedures, such as endoscopy, laparoscopy, arthroscopy, gonioscopy, thoracoscopy, cystoscopy, and the like. Many of these procedures involve delivering an insertable device to a site within a patient's body. In addition, many procedures involve delivering a medical device through a lumen within the insertable device. In particular, such procedures may be performed by inserting an insertable device (e.g., a duodenoscope) into a patient's body through a surgical incision or through a natural anatomical orifice (e.g., the mouth, vagina, or rectum) and using ancillary medical devices (e.g., a sphincterotome) inserted into the insertable device to perform the procedure or surgery at the target site.

[0003] The insertion instrument and the medical device each have one or more lighting devices (e.g., LEDs), visualization devices (e.g., cameras), etc., and require a power source, display devices, etc. Positioning the medical device at the target area relies on the maneuverability of the insertion instrument. Limited indirect control of the medical device through insertion instrument movement increases the time, expense, training time, and risk of the medical procedure.

[0004] The apparatus and methods of the present invention may remedy some of the above-mentioned deficiencies of the prior art or address other aspects thereof. Summary of the Invention [Means for solving the problem]

[0005] The present invention relates to systems and devices for connecting and controlling medical devices and performing one or more medical procedures using the medical devices, methods of use thereof, and other aspects. Each of the examples disclosed herein may include one or more features described in connection with any of the other disclosed examples.

[0006] In one example, the medical device includes a handle including a proximal portion and a distal portion, the proximal portion being pivotable relative to the distal portion. The medical device also includes an insert portion coupled to the distal portion of the handle and configured to be positioned within a body lumen, and an articulation wire extending from the handle and through the insert portion. By pivoting the proximal portion of the handle relative to the distal portion of the handle, the articulation wire can be moved relative to the insert portion, causing the distal portion of the insert portion to bend.

[0007] The medical device may include one or more of the following features. The medical device may further include an ablation wire extending through the insert and an actuator disposed on the handle and configured to supply energy from an energy source to the ablation wire. The articulation wire may be a first articulation wire, and the device may further include a second articulation wire extending from the handle through the insert and an actuator disposed on the handle, the second articulation wire configured to move the distal portion of the insert when the actuator is actuated. The handle may be a first handle and further include an attachment clamp configured to couple the first handle to a second handle of a second medical device, the attachment clamp including the first clamp, a second clamp, and an arm extending between the first clamp and the second clamp, the arm configured to space the first handle from the second handle. The insert may include an irrigation lumen, a guidewire lumen, and an ablation lumen accommodating the ablation wire. The handle is coupled to the insert via a rotatable coupling assembly, and the handle is configured to move the joint wire by pivoting about the rotatable coupling assembly.

[0008] The medical device may include one or more of the following features: the joint wire may be a first joint wire, and the rotatable coupling assembly may include a first gear at a distal end of the proximal portion of the handle, a second gear meshing with the first gear, the first joint wire being coupled to the second gear, and a third gear meshing with the first gear, the second joint wire being coupled to the third gear; the joint wire may be a first joint wire, and the rotatable coupling assembly may include a pair of flanges coupled to the proximal portion of the handle, a first cam, the first joint wire being coupled to the first cam, and a second cam, the second joint wire being coupled to the second cam, the flange pairs engaging the first and second cams to move the first and second joint wires, respectively. The joint wire may be a first joint wire, and the rotatable coupling assembly may include a first gear at a distal end of the proximal portion of the handle, a second gear in mesh with the first gear, the second gear arranged to rotate about a first axis and the second gear arranged to rotate about a second axis extending transverse to the first axis, the first joint wire being coupled to the second gear, and a third gear in mesh with the first gear, the third gear arranged to rotate about a third axis extending transverse to the first axis, the second joint wire being coupled to the third gear. The handle may be L-shaped and may include a rotatable coupling assembly configured to be directly coupled to a port of a second medical device, the handle configured to move the joint wire by pivoting about the rotatable coupling assembly. The handle is cylindrical and formed of a flexible material, and includes a coupler at a distal end of the handle configured to rigidly couple the handle to a port of a second medical device, and a proximal portion of the handle bends to move the joint wires. When the first gear rotates in a clockwise direction, the second gear and the third gear may rotate in a counterclockwise direction, and when the second gear rotates in a counterclockwise direction, the first joint wire may move proximally, and when the third gear rotates in a counterclockwise direction, the second joint wire may move distally.

[0009] In some examples, the medical device may include one or more of the following features: the first gear is proximal to the second and third gears, the second and third gears are disposed on opposite sides of a central longitudinal axis of the handle, and the proximal handle portion may pivot about a center of the first gear; when the proximal handle portion pivots, the first flange or the second flange of the flange pair may move at least one of the first cam or the second cam proximally and move at least one of the first joint wire or the second joint wire proximally, each of the first cam and the second cam having a pivot axis proximal to the flange pair. By pivoting the proximal portion of the handle in a first direction, 1) the first flange can move the first cam proximally, and 2) the second flange can move distally, allowing the second cam to move distally; and by pivoting the proximal portion of the handle in a second direction, 1) the second flange can move the second cam proximally, and 2) the first flange can move distally, allowing the first cam to move distally.

[0010] In another example, a medical device may include a handle, an insert coupled to the handle and configured to be disposed within a body lumen, and first and second joint wires each extending through the insert and having a proximal end coupled to the handle and a distal end coupled to the distal end of the insert. The handle may include a coupler including one of first and second gears or first and second cams, and the first and second joint wires are coupled to one of the first and second gears or one of the first and second cams, respectively, such that pivoting a portion of the handle relative to the coupler moves at least one of the first and second joint wires to bend the distal end of the insert.

[0011] The medical device may include one or more of the following features: the coupler may include first and second gears and the handle may include a third gear, wherein the third gear simultaneously moves the first and second gears when a portion of the handle is pivoted relative to the coupler; the coupler includes first and second cams and the handle includes a pair of flanges configured to move the first cam and the second cam when the handle is pivoted relative to the coupler.

[0012] In yet another example, a method includes inserting a distal portion of a first insertion section of an insertion instrument into a patient's body, the insertion instrument including a first handle coupled to the first insertion section, coupling a second handle of a medical instrument to the first handle, the medical instrument including a second insertion section coupled to the second handle of the medical instrument, inserting a second insertion section of a second medical instrument into the patient's body through a lumen of the insertion instrument, and moving the distal portion of the second insertion section by pivoting the second handle relative to the remainder of the medical instrument. The method may further include moving the distal portion of the second insertion section by actuating an actuator of the second handle.

[0013] It is to be understood that both the foregoing general description and the following detailed description are exemplary and explanatory only and are not restrictive of the present disclosure, as defined by the appended claims. The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate exemplary aspects of the present disclosure and, together with the description, serve to explain the principles of the disclosure. [Brief explanation of the drawings]

[0014] [Figure 1A] 1 illustrates an exemplary medical system including two medical devices in a linked state, according to an embodiment of the present disclosure. [Figure 1B] 1B is a cross-sectional view of an exemplary portion of the medical device of FIG. 1A according to an embodiment of the present disclosure. [Figure 2A]1B illustrates a portion of the exemplary medical device of FIG. 1A according to an embodiment of the present disclosure. [Figure 2B] 1 illustrates a distal portion of an exemplary medical device according to aspects of the present disclosure. [Figure 3] 2B is a side view of exemplary internal components of the medical device shown in FIG. 2A according to an embodiment of the present disclosure. [Figure 4A] 4A-4C show the internal components of FIG. 3 in different positions, according to an embodiment of the present disclosure. [Figure 4B] 4A-4C show the internal components of FIG. 3 in different positions, according to an embodiment of the present disclosure. [Figure 4C] 4A-4C show the internal components of FIG. 3 in different positions, according to an embodiment of the present disclosure. [Figure 5] 2B is a side view of exemplary internal components of the medical device shown in FIG. 2A according to another embodiment of the present disclosure. [Figure 6A] 6A-6C show the internal components of FIG. 5 in different positions, according to an embodiment of the present disclosure. [Figure 6B] 6A-6C show the internal components of FIG. 5 in different positions, according to an embodiment of the present disclosure. [Figure 6C] 6A-6C show the internal components of FIG. 5 in different positions, according to an embodiment of the present disclosure. [Figure 6D] 6A-6C show the internal components of FIG. 5 in different positions, according to an embodiment of the present disclosure. [Figure 7] 2B is a side view of exemplary internal components of the medical device shown in FIG. 2A according to another embodiment of the present disclosure. [Figure 8] 2B is a side view of exemplary internal components of the medical device shown in FIG. 2A according to another embodiment of the present disclosure. [Figure 9] FIG. 9 is a side view of some of the internal components shown in FIGS. 7 and 8, according to an embodiment of the present disclosure. [Figure 10] 1 illustrates a portion of an exemplary medical system including two medical devices in a linked state, according to an embodiment of the present disclosure. [Figure 11] 11 illustrates a portion of the exemplary medical device of FIG. 10, according to an embodiment of the present disclosure. [Figure 12] 1 illustrates a portion of an exemplary medical system including two medical devices in a linked state, according to an embodiment of the present disclosure. [Figure 13] 1 illustrates a portion of an explicit medical device according to aspects of the present disclosure. [Figure 14] 1 illustrates a portion of an exemplary medical device according to aspects of the present disclosure. DETAILED DESCRIPTION OF THE INVENTION

[0015] The present invention includes devices and systems for facilitating the manipulation of medical devices during a medical procedure and improving their effectiveness, efficiency, and / or safety. For example, embodiments of the present invention may provide a user (e.g., a physician, medical technician, or other medical professional) with the ability to physically connect and manipulate two handles of two medical devices (e.g., an insert device and a medical device). Embodiments of the present invention may also provide a user with the ability to deliver the insert device to a site within a patient's body and deliver the medical device through the insert device's internal lumen to a site within the patient's body, for example, to visualize, ablate, energize, treat, or manipulate tissue or material within the patient's body.

[0016] Embodiments of the present invention relate to systems for performing various medical procedures and methods for accessing the minor papilla and / or bile duct and / or any other suitable internal structure of a patient. Various embodiments described herein may include single-use, i.e., disposable, medical devices. In exemplary embodiments, the medical system delivers and positions a visualization and / or access device, e.g., a dissector such as a sphincterotome, to access the papilla of Vata or major papilla. The papilla of Vata generally forms the opening through which the pancreatic duct and common bile duct connect to the duodenum of the small intestine. The bile duct and gallbladder connect to the common bile duct. Endoscopic or biliary procedures require advancing a medical device along the biliary tree to the appropriate location to perform the appropriate procedure. The medical devices and methods disclosed herein enable access to and visualization of the minor papilla and / or pancreaticobiliary system, as well as other regions (as well as delivery systems for visualization and access devices). For example, the insertion instrument may be a duodenoscope, which is delivered to gain access to the minor papilla, and a medical instrument may be inserted through the duodenoscope and extend beyond the duodenoscope's insertion point into the bile duct. In some aspects, the medical instruments and methods disclosed herein are used to perform cannulation or endoscopic sphincterotomy (EST), which are procedures related to endoscopic retrograde cholangiopancreatography (ERCP).

[0017] Some aspects of the present invention may be used in performing endoscopic, laparoscopic, arthroscopic, or other types of procedures. For example, the disclosed aspects may be used with duodenoscopes, bronchoscopes, ureteroscopes, catheters, diagnostic or therapeutic instruments or devices, or other types of medical devices.

[0018] Reference will now be made in detail to examples of the present invention described above and illustrated in the accompanying drawings. Wherever possible, the same reference numerals refer to the same or similar parts throughout the drawings. The terms "proximal" and "distal" are used herein to refer to the relative locations of components of exemplary medical devices. As used herein, "proximal" refers to a location relatively closer to the exterior of the body or closer to the medical practitioner using the medical device. Conversely, "distal" refers to a location relatively farther from the medical practitioner using the medical device or closer to the interior of the body. The proximal and distal directions are indicated throughout the drawings by arrows labeled "P" and "D," respectively. As used herein, the terms "comprises," "having," "including," or other variations thereof are intended to cover a non-exclusive inclusion, such that a device or method comprising the listed elements does not include only those elements, but may also include other elements not expressly listed or inherent thereto. Unless otherwise specified, the term "exemplary" is used in the sense of "example" rather than "ideal." As used herein, the terms "about," "substantially," and "nearly" indicate a numerical range of + / - 10% of the specified numerical value.

[0019] FIG. 1A shows a medical system 100 including an insert instrument 102 and a medical instrument 101. FIG. 1A shows the insert instrument 102 and the medical instrument 101 in a coupled state. The insert instrument 102 can be an endoscope, duodenoscope, bronchoscope, ureteroscope, colonoscope, or other type of medical instrument. In one embodiment, the insert instrument 102 can be a disposable medical instrument. In another embodiment, the insert instrument 102 can be a reusable medical instrument. The medical instrument 101 can be a sphincterotome, other dissector catheter, or other type of medical instrument.

[0020] The insert instrument 102 has a handle portion 115 and an insert portion 113 that can be inserted into a patient's body lumen during a medical procedure. The insert portion 113 can be coupled to the handle portion 115. The handle portion 115 can include one or more actuators for actuating control wires or other mechanisms of the insert instrument 102. A working channel port 117 is disposed on the handle portion 115 and provides access to a working channel that extends longitudinally through the insert instrument 102. The working channel port 117 is used to pass one or more instruments or other devices (e.g., portions of the medical device 101) through the working channel of the insert portion 113 to the distal portion 150 of the insert instrument 102. In other examples, the insert instrument 102 can include multiple working channels that extend longitudinally through the insert portion 113. The distal portion of the insertion section 113 may include one or more cameras 116, one or more illuminators 118, and an opening 114 in the working channel of the insertion instrument 102. The one or more cameras 116 and the one or more illuminators 118 are connected to a controller in the handle portion 115 of the insertion instrument 102 and / or to a control unit (not shown) electrically connected to the insertion instrument 102. A user may visualize the camera image from the camera 118 using an electronic display (not shown).

[0021] The handle portion 115 may include multiple components that an operator uses to control the insert instrument 102 before, during, or after a procedure involving the insert instrument 102. For example, the actuator 108 may be used to control deflection of the distal portion 150 of the insert portion 113. In some examples, the actuator 108 may also include two knobs used to deflect the distal portion 150 of the insert portion 113. One of the knobs may be configured to deflect the distal portion 150 of the insert portion 113 along a first axis, and the other knob may be used to deflect the distal portion 150 of the insert portion 113 along a second axis that is transverse to the first axis. For example, the first knob may be operable to deflect the distal portion 150 of the insert portion 113 left and right, and the other knob may be operable to deflect the distal portion 150 of the insert portion 113 up and down. Although not shown, the actuator 108 may also include one or more locking mechanisms, which may be used to restrict the distal portion 150 of the insertion portion 113 from moving left and / or right and / or up and down, or to lock the position of the distal portion 150 of the insertion portion 113.

[0022] The medical instrument 101 includes an insertion portion 103 and a handle portion 105. As shown in FIG. 1A , the handle portion 105 is coupled to a handle portion 115 of the insert instrument 102 via a mounting clamp 107. The insertion portion 103 is inserted through a working channel port 117 and through the insertion portion 113 of the insert instrument 102, such that the insertion portion 103 can extend through and distally beyond a distal portion 150 of the insertion portion 113 into the patient's body during a medical procedure. The distal end 104 of the insertion portion 103 moves independently of the insertion portion 113 within the patient's body during a medical procedure. The insertion portion 103 can be coupled to the handle portion 105.

[0023] The mounting clamp 107 includes a first clamp 190 configured to be coupled to the handle portion 105, a second clamp 191 configured to be coupled to the handle portion 115, and an arm 192 rigidly coupled to each of the first clamp 190 and the second clamp 191. The second clamp 191 is disposed at an intermediate position on the handle portion 115, for example, proximal to the working channel port 117 and distal to the actuator 108. The arm 192 spaces the handle portion 105 from the handle portion 115, thereby facilitating operation of the medical system 100 and providing a more ergonomic position for the operator's hand. In another example, the medical instrument 101 can be directly coupled to the working channel port 117 via a snap-fit ​​coupler without using the mounting clamp 107.

[0024] The handle portion 105 of the medical device 101 is movable relative to a longitudinal axis E of the handle portion 105, as shown by arrows B and C in FIG. 1A. The handle portion 105 is pivotable or tiltable relative to a rotatable coupling assembly 203 (as shown in FIG. 2A), such that the proximal end (e.g., where the actuator 201 is located) can move away from the longitudinal axis E in any lateral direction radially outward from the longitudinal axis E (as shown by arrows B and C). The handle portion 105 can include an energy port 111 configured to be connected to a source of energy, such as electrical energy. The energy port provides energy to a cauterization element 140 (e.g., a wire, see FIG. 2B) of the medical device 101. The handle portion 105 can be configured to connect to a power source, such as ... irrigation configured to allow access to the lumen irrigation Port 109 may also be included. irrigation Port 109 is connected to a fluid source, such as a water or saline source. irrigationPort 109 may also be used as a suction port for suction purposes. Additionally, handle portion 105 may include a guidewire port 112 configured to receive a guidewire and provide access to guidewire lumen 139. Handle portion 105 may also include one or more actuators 201, 209 for manipulating various portions of medical device 101. Actuators 201, 209 are described in more detail below with respect to FIG. 2A.

[0025] 1B shows a cross-sectional view of the insertion portion 103 taken along the line A. The insertion portion 103 includes joint lumens 131, 133, irrigation lumen 135, cauterization lumen 137, and guidewire lumen 139. irrigation Lumen 135 , cauterization lumen 137 , and guidewire lumen 139 each extend longitudinally through insertion section 103 to distal end 104 . irrigation Lumen 135 is irrigation , and can be used for suction. Each joint lumen 131, 133 is configured to receive a joint wire 141, 142, which is coupled to a distal portion of the insertion portion 103 (e.g., coupled to the distal end 104) and movable within the joint lumen 131, 133. The joint lumens 131, 133 are disposed on opposite sides of the insertion portion 103, e.g., on opposite sides of the central longitudinal axis of the insertion portion 103, and are adjacent to the outermost surface 147 in the radial direction from the central longitudinal axis of the insertion portion 103. In some examples, the joint lumens 131, 133 can be equidistant from the central longitudinal axis of the insertion portion 103. The joint wires 141, 142 can be formed of any suitable material, such as stainless steel, nitinol, or plastic. In other examples, the joint lumens 131, 133 house a bellows or any other flexible structure to enable steerability of the insertion portion 103. In some examples, the bellows may be soft robotics used to provide good maneuverability for the insert 103 .

[0026] irrigationThe lumen 135 is connected to a fluid source to provide a means for deploying fluid from the distal end 104 of the insertion portion 103, and is connected to a suction source (air suction or vacuum) to provide a means for applying suction from the distal end 104 of the insertion portion 103. The ablation lumen 137 is configured to receive the ablation wire 140, which receives and heats energy to ablate patient tissue. The ablation wire 140 travels within the ablation lumen 137. The guidewire lumen 139 receives a guidewire to facilitate positioning the insertion portion 103 within the working channel of the insertion portion 113. In other examples, the insertion portion 113 may include three, four, five, or any other suitable number of articulation lumens 131, 133 for positioning articulation wires 141, 142. For example, the insert 103 includes four joint lumens 131, 133 spaced equidistant from the central longitudinal axis of the insert 103, with each of the four joint lumens 131, 133 positioned proximate a surface 147 radially outermost from the central longitudinal axis of the insert 103. In some examples, the insert 103 may include additional lumens for accommodating other components of the medical device 101. In other examples, the insert 103 may include four joint lumens 131, 133, irrigation It is also possible to omit one or more of lumen 135, cauterization lumen 137, and guidewire lumen 139.

[0027] 2A shows a portion of the medical instrument 101, including the handle portion 105 and the insertion portion 103, as well as an enlarged view of each portion of the handle portion 105. The handle portion 105 includes a proximal portion 205 and a distal portion 207. The proximal portion 205 is movable relative to the distal portion 207, and the proximal portion 205 may be coupled to the distal portion 207 via a rotatable coupling assembly 203. The rotatable coupling assembly 203 may be a hinge joint or a ball-and-socket joint. The rotatable coupling assembly 203 allows the proximal portion 205 to rotate relative to the distal portion 207, such that the proximal portion 205 pivots about a point within the rotatable coupling assembly 203. In some examples, the rotatable coupling assembly 203 may be a ball-and-socket joint and / or a friction ball-and-socket joint mechanism. The proximal section 205 can pivot about the rotatable coupling assembly 203 such that the proximal end of the proximal section 205 moves away from the central longitudinal axis Z of the medical device 101, while the distal end of the proximal section 205 remains aligned with the central longitudinal axis Z. The rotatable coupling assembly 203 provides a means for a user to move the distal end 104 of the insertion section 103 by moving one or more of the articulation wires 141, 142.

[0028] The handle portion 105 also includes a first actuator 201 at a proximal portion 205 of the handle portion 105, e.g., at the proximal end of the handle portion 105. The first actuator 201 is rotatable about a longitudinal axis Z and moves the distal end 104 via one or more actuation wires 141, 142. The first actuator 201 is rotatable relative to the proximal portion 205. In some examples, rotation of the first actuator 201 can simultaneously move both actuation wires 141, 142 in a proximal or distal direction, moving the distal end 104 up or down. In some examples, the first actuator 201 can elevate the distal end 104 and function as an elevator actuator. The handle portion 105 can further include a second actuator 209. The second actuator 209 turns the supply of energy to the ablation wire 140 on and off. In other examples, a separate actuator, such as a foot pedal or other button, turns on and off the supply of energy to the ablation wire 140. The second actuator 209 is disposed proximal to the proximal portion 205 and can be a slidable and / or rotatable switch actuator. In some examples, the second actuator 209 actuates the distal end 104 and / or the ablation wire 140. For example, rotation of the second actuator 209 can bend the ablation wire 140 to assist in cutting tissue.

[0029] In operation, the medical system 100 is used to perform a medical procedure within a patient's body. First, the insertion portion 113 of the insertion instrument 102 is inserted into the patient's body, for example, through an incision or a natural orifice in the patient. Once the insertion portion 113 is positioned at a target site within the patient's body, a user inserts the insertion portion 103 of the medical device 101 into the working channel port 117 and positions the distal end 104 of the insertion portion 103 proximate to the target site. In another example, prior to inserting the insertion portion 113 into the patient's body, the user positions the insertion portion 103 within the working channel of the insertion portion 113. Once both the insertion portion 113 and the insertion portion 103 are positioned at the target site, the user can manipulate the actuator 108 of the insertion instrument 102 to move the distal portion of the insertion portion 113. The user can also manipulate the handle portion 105 of the medical device 101 to move the distal end 104 of the insertion portion 103 independently of the insertion portion 113. For example, the user may pivot the proximal portion 205 relative to the distal portion 207 of the handle portion 105 to move the distal end 104 left and right, and may rotate the first actuator 201 to move the distal end 104 up and down.

[0030] The user also initiates ablation using the ablation wire 140 by actuating the second actuator 209 or a foot pedal actuator (not shown). For example, the user moves the ablation wire 140 distally through the ablation lumen 137 to position the ablation wire 140 within the patient's body, and then actuates the second actuator 209 (or the foot pedal actuator) to apply energy to the ablation wire 140 and ablate tissue. In other examples, the distal end 104 may include an opening configured to expose the ablation wire 140 to the exterior of the insertion section 103 when the distal end 104 is bent (see FIG. 2B ). In some examples, the user holds the handle portion 115 with one hand and operates the actuator 108 to move the insertion section 113, while using the other hand to hold the handle portion 105 and operate the actuators 201, 209 to pivot the proximal section 205 relative to the distal section 207. The mounting clamp 107 can fix the orientation of the distal portion 207 relative to the handle portion 115, allowing a user to pivot the proximal portion 205 relative to the distal portion 207 during operation. The user can also move the insertion portion 103 distally and / or proximally to change the position of the distal end 104. The medical instrument 101 allows a user to 1) pivot the proximal portion 205 relative to the distal portion 207 to move the distal end 104 to the right or left, 2) operate the first actuator 201 to move the distal portion 207 up or down, or 3) move the insertion portion 103 distally or proximally relative to the insertion portion 113 by pulling or pushing the insertion portion 103 through the working channel of the insertion portion 113. Thus, the medical instrument 101 can provide a user with six degrees of freedom of movement of the distal end 104 during a procedure. By providing a means for moving the distal end 104 independently of the movement of the insertion portion 113, the medical system 100 may shorten procedure time, reduce undesired movement of the medical device 101, and reduce injury to the patient during the procedure.

[0031] 2B illustrates an exemplary distal portion 250 of an insert portion 251 of a medical device, such as medical device 101. The distal portion 250 may be included in any of the medical devices of the present disclosure. The distal portion 250 includes an opening 256 configured to expose the ablation wire 140 to the exterior of the insert portion 251 when the distal portion 250 is bent. The ablation wire 140 may be secured to a distal end 254 of the insert portion 251, and the opening 256 may allow the ablation wire 140 to transition from being disposed within the insert portion 251 to being disposed outside the insert portion 251 when the distal portion 250 is bent. In some examples, the distal portion 250 (or any other distal portion of a medical device described herein) includes a coil relief segment 252 to help prevent kinking of the distal portion 250 during operation. The coil relief segment 252 may be a biasing member such as a spring, a helical wire, or any other suitable material. The coil relief segment 252 may be formed from stainless steel, an alloy such as Nitinol, or any other material of suitable hardness. In some examples, the coil relief segment 252 is coated with a heat sink material, a plastic extrusion, or any other suitable material.

[0032] FIG. 3 illustrates an exemplary rotatable coupling assembly 351 for use with the medical instrument 101. The rotatable coupling assembly 351 is disposed within the handle portion 105 and provides a mechanism for moving the joint wires 356, 358. The joint wires 356, 358 are disposed within the joint lumens 131, 133. The rotatable coupling assembly 351 includes a rod 360 having a first gear 353 disposed at its distal end. The rod 360 extends longitudinally through the interior of the proximal portion 205 of the handle portion 105. In some examples, the rotatable coupling assembly 351 may not include the rod 360, and the first gear 353 may be integrated within the interior of the handle portion 105. As shown in FIG. 3 , the first gear 353 meshes with a second gear 355 and a third gear 357. The second gear 355 and the third gear 357 are disposed within the distal portion 207 of the handle portion 105. Articulation wire 356 is coupled to second gear 355, and articulation wire 358 is coupled to third gear 357. Rod 360 is rigidly coupled to proximal portion 205, such that rod 360 moves when proximal portion 205 moves. Rod 360 pivots about pivot point 370 when a user pivots proximal portion 205. As rod 360 pivots about pivot point 370, teeth 371 of first gear 353 mesh with teeth 372 of second gear 355 and teeth 373 of third gear 357, causing second gear 355 and third gear 357 to rotate. Rotation of second gear 355 may cause articulation wire 356 to move proximally or distally, for example, by winding or unwinding articulation wire 356 from a portion of second gear 355. Rotation of the third gear 357 may cause the joint wire 358 to move proximally or distally, for example, by winding or unwinding the joint wire 358 from a portion of the third gear 357 .

[0033] 4A-4C illustrate various positions of the rotatable coupling assembly 351 that may be used with the medical instrument 101 and the resulting effect on an exemplary distal portion 459 of the insert 403. FIG. 4A illustrates the rotatable coupling assembly 351 in a neutral position in which the rod 360 is aligned with the longitudinal axis F. In the neutral position shown in FIG. 4A, the distal portion 459 is aligned with the longitudinal axis F. As shown in FIG. 4B, when the user pivots the rod 360 to the right (rotating the gear 353 in a clockwise direction), the actuation wire 356 is moved proximally by the counterclockwise rotation of the second gear 355, and the actuation wire 358 is moved distally by the counterclockwise rotation of the third gear 357, causing the distal portion 459 to move to the right of the axis F. As shown in FIG. 4C , when the user pivots rod 360 to the left (rotating gear 353 counterclockwise), actuation wire 358 moves proximally due to the clockwise rotation of third gear 357, actuation wire 356 moves distally due to the clockwise rotation of second gear 355, and distal portion 459 moves to the left of axis F. In some examples, first actuator 201 on handle portion 105 is rotated about axis Z to move the entire rotatable coupling assembly 351 upward or downward (along axis F shown in FIGS. 4A-4C ), pulling both actuation wires 356, 358 proximally and raising or lowering distal portion 459. In some examples, first actuator 201 may include a screw and knob mechanism for moving actuation wires 356, 358.

[0034] FIG. 5 illustrates another exemplary rotatable coupling assembly 551 that can be used with the medical instrument 101. The rotatable coupling assembly 551 is disposed within the handle portion 105 and provides a mechanism for moving the joint wires 565, 566. The joint wires 565, 566 are disposed within the joint lumens 131, 133. The rotatable coupling assembly 551 can include a rod 505 having a distal end 564 including two flanges 571, 572. Each flange 571, 572 can extend outward from the longitudinal axis of the rod 505 and curve upward in the proximal direction. The rod 505 can extend longitudinally through the interior of the proximal portion 205 of the handle portion 105. In other examples, the rotatable coupling assembly 551 can eliminate the rod 505, and the flanges 571, 572 can be incorporated into the proximal portion 205 of the handle portion 105. Rod 505 may include an interior cavity 590 configured to house inner rod 567 and biasing member 568. Inner rod 567 may be movable within rod 505, and biasing member 568 may be wound around inner rod 567.

[0035] In some examples, when the first actuator 201 is rotated, the inner rod 567 moves proximally, causing the rotatable linkage assembly 551 to move proximally and pulling both articulation wires 565, 566 proximally, causing the distal portion of the medical device 101 to move upward or downward. When the first actuator 201 is released, the biasing member 568 may return the moveable assembly 551 to a neutral position (shown in FIG. 5 ). A crossbar 569 may be fixedly coupled to the distal end of the inner rod 567 and may be movable relative to the rod 505. A first cam 560 may be rotatably coupled to a first end 593 of the crossbar 569, and a second cam 561 may be rotatably coupled to a second end 594 of the crossbar 569 opposite the first end 593 of the crossbar 569. First cam 560 is rotatable about pivot point 562, and second cam 561 is rotatable about pivot point 563. Articulation wire 565 is coupled to a distal portion of first cam 560, and articulation wire 566 is coupled to a distal portion of second cam 561. Flange 571 is configured to engage first cam 560, and flange 572 is configured to engage second cam 561.

[0036] 6A-6D illustrate various positions of the rotatable coupling assembly 551 that may be used with the medical instrument 101, and the resulting effect on an exemplary distal portion 559 of the insert 503. FIG. 6A illustrates the rotatable coupling assembly 551 in a neutral position in which the rod 505 is aligned with the longitudinal axis G. In the neutral position shown in FIG. 6A, the distal portion 559 is aligned with the longitudinal axis G. As shown in FIG. 6B, when the user pivots the rod 505 to the right, the flange 572 pushes the second cam 561 proximally, causing the second cam 561 to rotate clockwise about the pivot point 563 and pull the articulation wire 566 proximally, resulting in the distal portion 559 moving to the right of the axis G. As shown in FIG. 6C, when the user pivots the rod 505 to the left, the flange 571 pushes the first cam 560 proximally, causing the first cam 560 to rotate counterclockwise about the pivot point 562 and pull the joint wire 565 proximally, resulting in the distal portion 559 moving to the left of the axis G.

[0037] In some examples, the inner rod 567 is coupled to an actuator in the handle portion 105, such as the first actuator 201, which moves the inner rod 567 proximally and distally. As shown in FIG. 6D , when the inner rod 567 moves proximally relative to the rod 505 (the proximal portion 205 of the handle portion 105), the crossbar 569, the first cam 560, the second cam 561, and the actuator wires 565, 566 all move proximally. When both articulation wires 565, 566 move proximally simultaneously, the distal portion 559 moves upward or downward. A biasing member 568 biases the inner rod 567, and when the user releases the actuator that moves the inner rod 567, the inner rod 567 moves to the neutral position (shown in FIG. 6A ) via the biasing member 568.

[0038] 7 and 8 illustrate another exemplary rotatable coupling assembly 751 that can be used within the medical instrument 101. The rotatable coupling assembly 751 can be disposed within the handle portion 105 and provide a mechanism for moving joint wires 756, 758. The joint wires 756, 758 are disposed within the joint lumens 131, 133. The rotatable coupling assembly 751 can include a rod 705 having a first gear 702 disposed at a distal end of the rod 705. The rod 705 can extend longitudinally through the interior of the proximal portion 205 of the handle portion 105. As shown in FIG. 7 , the first gear 702 can mesh with a second gear 703 and a third gear 704. The second gear 703 and the third gear 704 are disposed within the distal portion 207 of the handle portion 105. The joint wire 756 is coupled to the second gear 703, and the joint wire 758 is coupled to the third gear 704. The rod 705 may be fixedly coupled to the proximal portion 205, such that the rod 705 moves when the proximal portion 205 moves. In some examples, the rotatable coupling assembly 751 may not include the rod 705, and the first gear 702 may be incorporated into the proximal portion 205 of the handle portion 105. When a user rotates the proximal portion 205, the rod 705 pivots about a pivot axis Q that extends through the centers of the second gear 703 and the third gear 704. As the rod 705 pivots about the pivot axis Q, the first gear 702 meshes with the second gear 703 and the third gear 704, causing the second gear 703 and the third gear 704 to simultaneously rotate in either a clockwise or counterclockwise direction. Alternatively or additionally, rod 705 may also rotate about longitudinal axis H to mesh first gear 702 with second gear 703 and third gear 704, simultaneously rotating second gear 703 in a clockwise direction and third gear 704 in a counterclockwise direction, or vice versa when rod 705 is rotated in the opposite direction about longitudinal axis H. Guide members 706, 708 extend lengthwise, parallel to axis H, and receive a portion of rotatable linkage assembly 751.Guide members 706, 708 are fixedly coupled to handle portion 105, and rotatable coupling assembly 751 moves proximally or distally within handle portion 105, for example, when a user manipulates first actuator 201 or actuator 800 to move rotatable coupling assembly 751 proximally or distally. In some examples, second gear 703 is movably coupled to guide member 706, and third gear 704 is movably coupled to guide member 708. In some examples, second gear 703 and third gear 704 each move within a slot or lumen in guide member 706 and guide member 708, respectively.

[0039] The joint wire 756 is coupled to the second gear 703 at a location on axis Q opposite the location at which the joint wire 758 would be coupled to the third gear 704. By positioning and securing the joint wires 756, 758 on opposite sides of axis Q, the joint wire 756 moves distally when the second gear 703 is rotated clockwise, and the joint wire 758 moves proximally when the third gear 704 is rotated clockwise. Thus, when a user pivots the rod 705 about axis Q to simultaneously move the second gear 703 and the third gear 704 clockwise, the joint wire 756 moves distally and the joint wire 758 moves proximally. This mechanism allows a user to move the distal portion of the insertion section 703 to the right or left in a manner similar to that described above for the rotatable coupling assemblies 351, 551. When the user rotates the rod 705 about the longitudinal axis H, the second gear 703 and the third gear 704 rotate in opposite directions, causing both of the articulation wires 756, 758 to move proximally. When the user rotates the rod 705 about the longitudinal axis H, the distal portion of the insertion section 703 moves upward due to both of the articulation wires 756, 758 moving proximally, in a manner similar to that described above with respect to FIG. 6D .

[0040] In some examples, the actuator 800 is a screw actuator that rotates on the threaded portion 901 of the rod 705. The actuator 800 moves the rotatable assembly 751 proximally or distally through rotation of the actuator. In some examples, the actuator 800 is exposed outside of the handle portion 105.

[0041] FIG. 10 shows the proximal portion of an alternative embodiment of a medical instrument 1001 coupled to a handle portion 1015 of an insert instrument 1002. The insert instrument 1002 and medical instrument 1001 may have any of the features described above for the insert instrument 102 and medical instrument 101. As shown in FIG. 11 , the medical instrument 1001 may include an insert portion 1003, a rotatable coupling assembly 1006, and a handle portion 1005. The handle portion 1005 may include any of the other handle portion components described in this disclosure. The handle portion 1005 may be L-shaped and include a lateral portion 1008 and a distal portion 1009. The distal portion 1009 is aligned with the longitudinal axis J of the medical instrument 1001, and the lateral portion 1008 extends radially outward from the proximal end of the distal portion 1009 relative to the longitudinal axis J. The rotatable coupling assembly 1006 is directly coupled to the working channel port 1017 of the handle portion 1015. The lateral portion 1008 is held by the user during operation. Once coupled to the working channel port 1017 of the handle portion 1015, the user rotates the handle portion 1005 relative to the handle portion 1015, pivoting the handle portion 1005 about the rotatable coupling assembly 1006 and moving the distal portion of the insertion portion 1003 right, left, up, or down. In some examples, the rotatable coupling assembly 1006 includes a ball-and-socket joint with an interference fit, allowing the user to release the handle portion 1005 during operation to maintain the position of the medical device 1001 without holding the handle portion 1005. In some examples, the rotatable coupling assembly 1006 snaps into the working channel port 1017.

[0042] FIG. 12 illustrates an alternative embodiment of a medical instrument 1201 coupled to a handle portion 1215 of an insert instrument 1202. The insert instrument 1202 and medical instrument 1201 may include any of the features described above for the insert instruments 102, 1002 and medical instruments 101, 1001. The medical instrument 1201 may include a handle portion 1205, a coupling portion 1207, and an insert portion (not shown). The handle portion 1205 may include any of the other handle portion components described in this disclosure. The handle portion 1205 may be cylindrical and formed of a flexible mesh material configured to bend when a user moves the handle portion laterally relative to the central longitudinal axis K of the medical instrument 1201. In other examples, the handle portion 1205 may be made of any other flexible material. The coupling portion 1207 fixedly couples the handle portion 1205 to a working channel port 1217 of the handle portion 1215. For example, coupling portion 1207 snaps into working channel port 1217. In operation, a user bends handle portion 1205 laterally relative to central longitudinal axis K (shown in FIG. 12 as bent handle portions 1290, 1291 in dotted lines) to move the articulation wires of medical device 1201 and to move the distal portion of the insert portion of medical device 1201. For example, a user bends handle portion 1205 to the right to move the distal portion of the insert portion to the right, and bends handle portion 1205 to the left to move the distal portion of the insert portion to the left. In some examples, medical device 1201 allows a user to move the insert portion right, left, up, down, and / or diagonally.

[0043] 13 illustrates the proximal portion of another alternative embodiment of a medical instrument 1301 configured to be inserted into the working channel of the insert instrument 102, 1002, 1202. The medical instrument 1301 may have any of the features described above for the medical instrument 101, 1001, 1201. The medical instrument 1301 may include a handle portion 1305 and an insert portion 1303. The handle portion 1305 may include any of the other handle portion components described in this disclosure. The handle portion 1305 may be generally rectangular in cross section and may include a curved portion 1321 and a proximally-facing generally rectangular surface 1306. The curved portion 1321 allows a user to access the proximal-facing surface 1306 with their thumb while gripping the handle portion 1305. The proximal-facing surface 1306 is flat and angled relative to the central longitudinal axis of the medical instrument 1301. Three actuators 1308, 1309, 1310 may be disposed on the proximal-facing surface 1306. In other examples, there may be one, two, four, five, or any other suitable number of actuators on the proximal-facing surface 1306. Each actuator 1308, 1309, 1310 may be a knob positioned within and move within a groove 1312, 1311, 1313, respectively, in the proximal-facing surface 1306. A guidewire lumen opening 1315 may also be disposed on the proximal-facing surface 1306. The guidewire lumen opening 1315 is centrally disposed in the proximal-facing surface 1306 and provides access to a guidewire lumen extending longitudinally through the insert 1303. The guidewire lumen opening 1315 receives a guidewire 1380.

[0044] Any of the actuators 1308, 1309, and 1310 can be used to move the distal portion of the insertion portion 1303 left and right, up and down, diagonally, and / or bend the distal portion of the insertion portion 1303. In some examples, the actuators 1308, 1309, and 1310 bend the distal portion of the insertion portion 1303 to position the cauterization wire 140. In some examples, the actuator 1310 moves the distal portion of the insertion portion 1303 up and down relative to the central longitudinal axis of the medical device 1301 by moving the actuator 1310 within the groove 1313. The actuator 1308 moves the distal portion of the insertion portion 1303 left and right by moving the actuator 1308 within the groove 1312, and the actuator 1309 bends the distal portion of the insertion portion 1303 by moving the actuator 1309 within the groove 1311. In some examples, bending the distal portion of the insertion portion 1303 can expose the ablation wire 140 outside the insertion portion 1303. In other examples, one or more actuators 1308, 1309, 1310 actuate any other mechanism of the medical device 1301, such as initiating the delivery of energy to the ablation wire 140. By locating the actuators 1308, 1309, 1310 on the proximal-facing surface 1306, the handle portion 1305 provides an ergonomic way for a user to actuate each actuator 1308, 1309, 1310 with only one hand. In some examples (not shown), the handle portion 1305 can include a snap-fit ​​coupler for connecting the handle portion 1305 to a working channel port 117, 1017, 1217 of the insertion instrument 102, 1002, 1202. In other examples, the handle portion 1305 can be coupled to the insert instrument 102 , 1002 , 1202 using a mounting clamp 107 .

[0045] In operation, a user moves the actuators 1308, 1309, 1310 within the grooves 1311, 1312, 1313 to move a distal portion of the insert portion 1303 of the medical device 1301. For example, a user actuates the actuator 1310 by sliding the actuator 1310 within the groove 1313 to move the distal portion of the insert portion 1303 up or down. In some examples, the medical device 1301 allows a user to move the insert portion right, left, up, down, and / or diagonally.

[0046] FIG. 14 shows the proximal portion of an alternative embodiment of a medical instrument 1401 inserted into the working channel of the insert instrument 102, 1002, 1202. The medical instrument 1401 may include any of the features described above with respect to the medical instrument 101, 1001, 1201, 1301. The medical instrument 1401 may include a handle portion 1405 and an insert portion (not shown). The handle portion 1405 may include any of the other handle portion components described in this disclosure. The handle portion 1405 includes a curved surface 1422 and a flat surface 1423, both of which extend circumferentially about a central longitudinal axis W of the medical instrument 1401. The curved surface 1422 fits within a user's hand, e.g., the palm of the hand. A lever 1408 is disposed on the flat surface 1423 and is operated by the user's thumb. The rotation knob 1407 may be disposed on the curved surface 1422 and proximal to the lever 1408. The rotation knob 1407 may be cylindrical and longitudinally aligned with the longitudinal axis W. The rotation knob 1407 may include a longitudinally extending ridge on the outer surface of the rotation knob 1407. The lever 1408 and the rotation knob 1407 may be configured to actuate movement of a distal portion of the insertion section of the medical device 1401, such as moving the distal portion of the insertion section left and right, up and down, or bending the distal portion of the insertion section. The handle portion 1405 may also include an ablation input portion 1416 configured to receive energy from an energy source and deliver energy to the ablation wire 1400. A guidewire port 1415 is disposed proximal to the handle portion 1405 to receive a guidewire 1480. Guidewire port 1415 provides access to the guidewire lumen in the insertion portion of medical device 1401 .

[0047] To operate medical device 1401, a user grasps handle portion 1405 with the user's thumb adjacent lever 1408 and knob 1407. In some examples, the user rotates knob 1407 to move the distal portion of the insertion section left and right, and moves lever 1408 to move the distal portion of the insertion section up and down.

[0048] While the principles of the present disclosure have been described herein with reference to illustrative embodiments for particular applications, it should be understood that the present disclosure is not limited thereto. Other improvements, applications, embodiments, and equivalent substitutions may occur to those skilled in the art upon reference to the teachings provided herein, all of which are within the scope of the embodiments described herein. Therefore, the present disclosure is not deemed to be limited by the above description.

Claims

1. a handle including a proximal portion and a distal portion, the proximal portion pivoting relative to the distal portion; an insertion section coupled to the distal portion of the handle and configured to be placed within a body lumen; a first joint wire and a second joint wire extending from the handle through the insert; a first actuator disposed on the handle; Including, pivoting the proximal portion of the handle relative to the distal portion of the handle to move at least one of the first joint wire and the second joint wire relative to the insert portion to bend the distal portion of the insert portion; when the first actuator is actuated, both the first joint wire and the second joint wire are configured to move proximally to move the distal portion of the insertion section upward, or when the first actuator is actuated, both the first joint wire and the second joint wire are configured to move distally to move the distal portion of the insertion section downward.

2. a cauterization wire extending through the insertion section; The medical device of claim 1 , further comprising: a second actuator disposed on the handle and configured to supply energy from an energy source to the ablation wire.

3. 10. The medical instrument of claim 1, wherein the handle is a first handle and further includes an attachment clamp connecting the first handle to a second handle of a second medical instrument, the attachment clamp including a first clamp, a second clamp, and an arm extending between the first clamp and the second clamp, the arm configured to space the first handle from the second handle.

4. The medical device of claim 1 , wherein the insert includes an irrigation lumen, a guidewire lumen, and an ablation lumen that accommodates an ablation wire.

5. 2. The medical device of claim 1, wherein the handle is coupled to the insert via a rotatable coupling assembly, and the handle is configured to move the first joint wire and the second joint wire by pivoting about the rotatable coupling assembly.

6. The rotatable coupling assembly, a first gear at a distal end of the proximal portion of the handle; a second gear meshing with the first gear, the second gear having the first joint wire connected thereto; 6. The medical device of claim 5, further comprising: a third gear meshing with the first gear, the third gear having the second joint wire coupled thereto.

7. A handle including a proximal portion and a distal portion, the proximal portion pivoting relative to the distal portion; a rotatable coupling assembly coupled to the proximal and distal portions of the handle; an insertion section coupled to the distal portion of the handle and configured to be placed within a body lumen; a first joint wire and a second joint wire extending from the handle through the insert, the handle configured to pivot about the rotatable coupling assembly to move the first joint wire and the second joint wire; Including, pivoting the proximal portion of the handle relative to the distal portion of the handle to move at least one of the first joint wire and the second joint wire relative to the insert portion to bend the distal portion of the insert portion; The rotatable coupling assembly includes: a pair of flanges coupled to the proximal portion of the handle; a first cam to which the first joint wire is coupled; and a second cam to which the second joint wire is coupled, wherein the pair of flanges engage the first cam and the second cam to move the first joint wire and the second joint wire, respectively.

8. The rotatable coupling assembly: a first gear at a distal end of the proximal portion of the handle; a second gear meshing with the first gear, the second gear being arranged so that the first gear rotates about a first axis and the second gear rotates about a second axis extending transverse to the first axis, the first joint wire being coupled to the second gear; 6. The medical device of claim 5, comprising: a third gear meshing with the first gear, the third gear rotating about a third axis extending transverse to the first axis, and the second joint wire coupled to the third gear.

9. The medical instrument of claim 8 , wherein the handle is L-shaped and the rotatable coupling assembly is configured to be directly coupled to a port of a second medical instrument.

10. the handle is cylindrical and formed of a flexible material, the handle including a coupler at a distal end of the handle; the coupler is configured to fixedly couple the handle to a port of a second medical device; 8. The medical device of claim 7, wherein the proximal portion of the handle is configured to bend to move the first and second joint wires.

11. A handle including a proximal portion and a distal portion, the proximal portion pivoting relative to the distal portion; a rotatable coupling assembly coupled to the proximal and distal portions of the handle; an insertion section coupled to the distal portion of the handle and configured to be placed within a body lumen; a first joint wire and a second joint wire extending from the handle through the insert, the handle configured to pivot about the rotatable coupling assembly to move the first joint wire and the second joint wire; Including, The rotatable coupling assembly includes: a rod extending longitudinally through the interior of the proximal portion of the handle and configured to pivot about a pivot point; a first gear at a distal end of the proximal portion of the handle; a second gear meshing with the first gear, the second gear having the first joint wire connected thereto; a third gear meshing with the first gear, the third gear being connected to the second joint wire; When the first gear rotates in a clockwise direction, the second gear and the third gear rotate in a counterclockwise direction; When the second gear rotates counterclockwise, the first joint wire moves proximally; When the third gear rotates in a counterclockwise direction, the second joint wire moves in a distal direction.

12. the first gear is proximal to the second gear and the third gear; the second gear and the third gear are disposed on opposite sides of a central longitudinal axis of the handle; The medical instrument of claim 11 , wherein the proximal portion of the handle pivots about a center of the first gear.

13. pivoting the proximal portion of the handle causes a first flange or a second flange of the pair of flanges to move at least one of the first cam or the second cam proximally and thereby move at least one of the first joint wire or the second joint wire proximally; The medical instrument of claim 7 , wherein the first cam and the second cam each have a pivot axis proximal to the pair of flanges.

14. Pivoting the proximal portion of the handle in a first direction causes 1) the first flange to move the first cam proximally, and 2) the second flange to move distally, allowing the second cam to move distally; 14. The medical device of claim 13, wherein pivoting the proximal portion of the handle in a second direction causes 1) the second flange to move the second cam proximally, and 2) the first flange to move distally, allowing the first cam to move distally.

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