Adjustable actuation mechanism for an endoscope - Patent application

Abstract

To provide a controller improved in operability.SOLUTION: A controller for an endoscope comprises a handle, a working channel opening connected to the handle at a first location, a control actuator connected to the handle at a second location, a first pull wire extending from the control actuator to the working channel opening within the handle, and a first pull wire tensioner through which the first pull wire extends, where the first pull wire tensioner is configured to remove slack from the first pull wire between the first location and the second location.SELECTED DRAWING: Figure 10A

Description

[Technical Field]

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS This application claims the benefit of priority to U.S. Provisional Patent Application No. 63 / 385,841, filed December 2, 2022, the contents of which are incorporated herein in their entirety.

[0002] The present disclosure relates generally to medical devices including an elongated body, such as an endoscope, configured to be inserted into an incision or opening in a patient's anatomy to provide a diagnostic or treatment procedure.

[0003] More specifically, the present disclosure relates to a control device that may be attached to a proximal portion of an elongate body for controlling or positioning a diagnostic or treatment device attached to a distal portion of the elongate body. [Background technology]

[0004] Endoscopes can be used for one or more of: 1) providing passage of therapeutic or other devices, such as tissue retrieval devices, to various anatomical portions, such as the digestive tract (e.g., esophagus, stomach, duodenum, pancreatic bile duct, intestines, and colon), renal region (e.g., kidneys, ureters, bladder, urethra), and other internal organs (e.g., reproductive system, sinus cavities, submucosal regions, airways, lungs).

[0005] Conventional endoscopes may be involved in a variety of clinical procedures, including, for example, illuminating, imaging, detecting, and diagnosing one or more disease states, providing fluid delivery (e.g., saline or other preparations via fluid channels) toward an anatomical region, providing passage of one or more therapeutic devices (e.g., via a working channel) for sampling or treating an anatomical region, and providing aspiration passages for withdrawing fluids (e.g., saline or other preparations), etc.

[0006] In conventional endoscopes, the distal portion of the endoscope may be configured to support and orient therapeutic devices such as biopsy devices, catheters, and ablation devices. Such systems can be useful when guiding the endoscope to difficult-to-reach anatomical locations within the body. For example, some anatomical locations can only be accessed with the endoscope after insertion through a circuitous path. Control of the endoscope to reach the anatomical location is performed by a control device attached to the proximal portion of the device. Sometimes, it may be necessary to control both the insertion scope and the therapeutic device, which form separate control devices. For example, it may sometimes be desirable to hold the position of the distal end of the endoscope with a control device for the endoscope, while operating a therapeutic device inserted into the endoscope with a separate control device.

[0007] In a further example, a duodenoscopy procedure (e.g., an endoscopic retrograde cholangiopancreatography, hereafter "ERCP" procedure) involves the use of an auxiliary scope (also called a dotascope or cholangioscope) that can be advanced through the working channel of a main scope (also called a motherscope or duodenoscope). Additionally, other devices, such as tissue retrieval devices used for biopsies, can be inserted into the auxiliary scope. This may require controlling the main scope, the auxiliary scope, and the treatment device with three separate control devices. Summary of the Invention [Problem to be solved by the invention]

[0008] In view of the foregoing, there is a continuing need to improve the operability of control devices for primary scopes, secondary scopes, and treatment devices. [Means for solving the problem]

[0009] The inventors have recognized that problems to be solved in conventional medical devices include, among other things, 1) the difficulty of operating multiple actuators, such as buttons and levers, on a control device. For example, some actuators are positioned to be finger-accessible for single-handed use, which can result in all of the actuators being difficult to reach for some users, such as those with relatively small hands. Also, some actuators are configured for double-handed use, which can sometimes result in awkward positioning of one hand relative to the other, which can lead to muscle fatigue after extended use. Furthermore, in other situations, the control device for an auxiliary scope or treatment device is sometimes attached to the control device for the primary scope, such as when the auxiliary scope or treatment device is introduced into the working channel of the primary scope. This coupling of the auxiliary control device to the primary control device can result in awkward positioning of the user's hand.

[0010] The present disclosure can provide solutions to these and other problems by providing systems, devices, and methods for ergonomic control for endoscopes and other scopes. Specifically, the present disclosure provides a scope control device having adjustably positionable control components or control actuators, whereby the position between two actuators or the position between an actuator and a docking feature for an auxiliary scope can be adjusted to provide more ergonomic and user-friendly positioning.

[0011] Additionally, the inventors have recognized that there are difficulties in fabricating an adjustable control over a range due in part to the presence of a pull wire in the control. For the pull wire to operate, it is desirable to eliminate slack in the pull wire. Slack in the pull wire results in a lack of responsiveness in the control actuator. As such, it is typically required that the pull wire control actuator be axially aligned with or have line of sight to the entrance to the working channel of the scope so that the appropriate tension can be applied to the pull wire.

[0012] The present disclosure can provide a solution to these and other problems by providing systems, devices, and methods for a pull wire that can be tensioned without line of sight between the control actuator and the working channel, thereby enabling the scope control device handpiece to separate the control actuator and working channel into offset, movable, or separate handpiece components.

[0013] In an example, a control device for an endoscope includes a handle, a working channel opening connected to the handle at a first location, a control actuator connected to the handle at a second location, a first pull wire extending from the control actuator to the working channel opening in the handle, and a first pull wire tensioner through which the first pull wire extends, the first pull wire tensioner configured to remove slack from the first pull wire between the first location and the second location. [Brief explanation of the drawings]

[0014] [Figure 1] 1 is a schematic diagram of a scope having a control device connected to a catheter. [Figure 2] 2 is a schematic cross-sectional view of a handle for the catheter of FIG. 1 showing an elongated catheter body extending therethrough. [Figure 3] FIG. 3 is a schematic diagram of the distal portion of the catheter of FIG. 2. [Figure 4] FIG. 4 is a schematic cross-sectional view of a distal portion of the catheter of FIGS. 2 and 3. [Figure 5] FIG. 5 is a schematic block diagram of an electronic system configured for use with the scope and catheter of FIGS. 1-4. [Figure 6] FIG. 2 is a side view of the control device of the scope of FIG. 1 showing the pull wires for controlling the distal tip of the scope. [Figure 7] FIG. 2 is a perspective view of the distal tip of the scope of FIG. 1 showing articulation of the distal tip. [Figure 8A] FIG. 1 is a perspective view of an adjustable control device of the present disclosure in a retracted state. [Figure 8B] FIG. 8B is a perspective view of the adjustable control device of FIG. 8A in an extended state. [Figure 9A] 8C is a perspective, partially cut-away view of the adjustable control device of FIG. 8B showing the sliding element for deploying the proximal control portion from the distal anchoring portion. [Figure 9B] FIG. 9B is an enlarged view of the sliding element of FIG. 9A. [Figure 10A] 1 is a cross-sectional view of an adjustable control device of the present disclosure including a pull wire tensioner of the present disclosure that accommodates a variable distance between portions of the handle of the control device. FIG. [Figure 10B] FIG. 10B is a cross-sectional view of the adjustable control device of FIG. 10A with the handle in an extended position and the pull wire tensioner straightened. [Figure 11] 10C is a cross-sectional view of the adjustable control device of FIGS. 10A and 10B showing an irregular cross-sectional shape to prevent rotation. FIG. [Figure 12] FIG. 10 is a cross-sectional view of a control device of the present disclosure having a handle with non-aligned end portions between which a pull wire tensioner of the present disclosure extends. [Figure 13] FIG. 1 is a schematic perspective view of a control device of the present disclosure having a handle with unconnected end portions between which a pull wire tensioner of the present disclosure extends. DETAILED DESCRIPTION OF THE INVENTION

[0015] 1 is a schematic diagram of a scope 10 having a control device 12 to which a catheter assembly 14 can be connected. The catheter assembly 14 can include a coupler 16, an extension 18, a rotating member 20, a handle 22, and a proximal grip 24. The scope 10 can include the control device 12, a scope shaft 26, an input cable 28A, an input cable 28B, a button 30A, a button 30B, a lever 32, and a working channel receptacle 34.

[0016] The catheter assembly 14, shown in more detail in FIGS. 2 and 3, may include an elongated catheter body 36 (FIG. 2) that terminates at a distal end section 33 (FIG. 3). The elongated catheter body 36 may extend from the proximal grip 24, through the rotating member 20, the handle 22, and the extension piece 18, to the coupler 16. The coupler 16 may be connected to the working channel receptacle 34 of the scope 10. Thus, the elongated catheter body 36 may be inserted into the working channel 84 (FIG. 6) of the scope shaft 26 of the scope 10. When assembled, the elongated catheter body 36 and the catheter assembly 14 may extend along a central longitudinal axis AA.

[0017] The catheter assembly 14 can be operated independently of the scope 10. The catheter assembly 14 can be steered by a handle 22 and by a rotating member 20. The handle 22 can be moved axially, as indicated by arrow 35, to move the elongated catheter body 36 axially relative to the scope 10. The rotating member 20 can be rotated, as indicated by arrow 38, to rotate the elongated catheter body 36 relative to the scope 10, which can be accomplished through steering of the rotating member 20 while the scope 10 remains stationary.

[0018] The scope 10 can be used to perform endobronchial interventions on a patient. For example, the scope shaft 26 can be inserted into the patient via the mouth to extend to the lungs. As discussed in more detail below, the scope shaft 26 can be guided to a location within the lungs via electromagnetic guidance. The handle 22 and rotating member 20 can be manipulated to guide the catheter assembly 14 and elongated catheter body 36, specifically through the scope 10 and into the patient's lungs. Thus, a physician can manipulate the elongated catheter body 36 via the scope 10 and the proximal grip 24 and handle 22 of the catheter assembly 14 to reach the desired anatomy. The lever 32 can be pushed or pulled to move the distal end of the scope shaft 26, as shown in FIG. 7 . Buttons 30A and 30B can be actuated to operate functions of the scope 10. For example, one of buttons 30A and 30B can be actuated to operate the imaging capabilities of scope 10, and the other of buttons 30A and 30B can be actuated to provide irrigation to scope shaft 26. In an example, input cable 28A can comprise a tube connected to a fluid supply, and input cable 28B can comprise an electrical cable connected to an electronics tower, including imaging, video, and treatment capabilities. Line 39 can connect input cable 28A to catheter assembly 14.

[0019] FIG. 2 is a schematic cross-sectional view of the handle 22 for the catheter assembly 14 of FIG. 1 showing the elongated catheter body 36 extending therethrough.

[0020] An extension piece 18 (FIG. 1) can be connected to the hub 37. The extension piece 18 can extend between the coupler 16 (FIG. 1) and the rotating member 20 (FIG. 1). The length of the extension piece 18 can be adjustable, such as via a telescopic movement, to move the handle 22 closer to the scope 10, thereby pushing the portion of the elongate catheter body 36 within the extension piece 18 further toward the scope 10 and the anatomy. The handle 22 can be pushed or pulled relative to the coupler 16 to provide large-scale adjustment to the position of the elongate catheter body 36 along the axis AA. The proximal grip 24 can be moved relative to the handle 22 to provide fine-scale adjustment to the position of the elongate catheter body 36 along the axis AA. In an example, the proximal grip 24 can provide sufficient movement of the elongated catheter body 36 to allow extension and retraction of the distal tip section 33 (FIG. 3) toward the distal end of the scope shaft 26 of the scope 10 and to provide small movements to sensors such as piezoelectric transducers or elements 43 and 44 (FIG. 4). In an example, the proximal grip 24 can move a distance D1 within the handle 22.

[0021] 3 shows the distal end section 33 of the elongate catheter body 36 separate from the catheter assembly 14. The distal end section 33 may include a functional component 40 and an opening 47 for a tool 49. In an example, the tool 49 may comprise a needle. The elongate catheter body 36 has a proximal access portal (not shown) and may include a lumen that may be connected to the opening 47. The lumen may be used to introduce the tool 49 into the elongate catheter body 36 and the scope 10.

[0022] 4 is a cross-sectional view of the distal end section 33 of the elongate catheter body 36. The distal end section 33 may include a functional component 40. In an example, the functional component 40 may include a multi-element planar ultrasound array 41. The multi-element planar ultrasound array 41 may be positioned parallel to the axis AA of the catheter assembly 14 and may be covered by an acoustic lens 42. The multi-element planar ultrasound array 41 may include a plurality of piezoelectric transducers or elements, such as element 43 and element 44, which may be fabricated into an array using micromachining techniques. An electronics package 45 may be positioned in the distal end section 33 near the electromagnetic coils 46 and 48.

[0023] A portion of the elongate catheter body 36 may be fabricated from stainless steel or other materials. The elongate catheter body 36 may include a laser-cut helical pattern to facilitate flexibility in one or more planes.

[0024] FIG. 5 illustrates the positioning of the catheter assembly 14 and its associated imaging system electronic components, and is illustrative but not limiting of the view of the system in this implementation.

[0025] The electronics package 45 of FIG. 4 may include, among other things, a programmable chip for configuring the multi-element planar ultrasound array 41. A multiplexer can format and transmit data from the catheter assembly 14 to a patient interface module 52 (or PIM 52), which may be suspended next to a gurney carrying the patient. The PIM 52 may include electrical insulation to protect the patient and may also include a power supply for the catheter assembly 14 itself. A / D conversion and various buffering processes may be performed in the PIM 52 to improve the noise characteristics of the catheter assembly 14. In this implementation, a separate "pizza box"-like enclosure may support dedicated hardware for synthetic aperture beamforming and control, as well as spectral analysis of the backscattered signals for the QUS process 54. The enclosure is coupled to a workstation-based guidance and display cart. The QUS backscatter evaluation system, located in the pizza box-like enclosure, may be separate or may be incorporated into the workstation 56 itself, displaying a visual image of the ultrasound signal and analysis.

[0026] The elongated catheter body 36 can support a matrix of individually addressable piezoelectric transducers or elements fabricated using micromachining techniques into a multi-element planar ultrasound array 41. Each element of the multi-element planar ultrasound array 41, shown as elements 43 and 44 in FIG. 4, can be powered to emit ultrasound energy as a spherical wave emanating from a specific transducer location, and each element in the array can function as a receiver to convert the mechanical energy of the backscattered sound into electrical energy. When a spherical wave is emitted from a given element 43, an accompanying transducer, such as element 44, can detect the backscattered energy reflected from biological tissue after a delay. In a synthetic aperture situation, only one element 44 listens to element 43 at a time.

[0027] Generally, pairs of elements are operated with one element 43 acting as a transmitter of acoustic energy and the other element 44 acting as a receiver. Because the elements are arranged in space, there are several viewpoints of the arrangement. This provides much improved lateral resolution when compared to prior art approaches.

[0028] That data is stored, the next transducer in the array is activated to transmit acoustic energy, and its complementary transducer receives the backscattered return signal. With many transducers, such as 64, at various locations, the combination of all the returned energy from all locations can be used, through calculations, to form an image plane orthogonal to the plane of the transducers.

[0029] Two or more pairs of transducers can be operated simultaneously, and in the illustrated embodiment, four channels of data can be collected synchronously. Limitations are based on complexity, power dissipation, and bandwidth of the data path. Consequently, other configurations are possible and are contemplated within the scope of the claims. The calculations for deriving an image in a plane from multiple time-sequenced data transmitted and received at various points in space are complex, but are well known and understood in the art. Generally, the displayed image plane is synthesized from data taken at many locations in space at different times, which are collectively convolved into a single image plane, hence the term synthetic aperture. As the catheter is moved along the path, the synthetic aperture image plane sweeps out a volume. While this is a relatively low-resolution image of the tissue volume, it can help determine the scale of biological structures to complement the detection of anatomical structures, such as airways and blood vessels, in the two-dimensional first image plane region. In this regard, the methodology of the present invention can rely on a first target image region in a plane, or on a three-dimensional volume, referred to as the first target image volume. In this latter case, the movement of the catheter is used to define a first three-dimensional volume of the target tissue.

[0030] During use, there are two modes of operation for an ultrasound transducer array. In the first mode, amplitude and envelope information from the backscattered acoustic energy is used to form an image presented to the clinician. This can be a first two-dimensional slice of the target tissue or a three-dimensional volume of the target tissue. In the second mode, the transmitted power is reduced to select a smaller target plane or volume within the first image plane or volume. This reduced field of view is referred to as a second reduced region or slice in the case of a two-dimensional slice, or a second reduced volume in the case of a three-dimensional volume. In each case, the reduced field of view is selected to be free of anatomical details observed in the first field of view. The elimination of macroscopic anatomical structures selects a homogenous sample for quantitative analysis. The spectrum of backscattered energy from the slice or volume of the reduced region is quantitatively and automatically evaluated rather than used to form an image. This image-free quantitative information is used to determine whether the reduced region of tissue exhibits the acoustic characteristics of cancerous tissue. The exact characteristics or acoustics of cancer are currently a topic of research.

[0031] Figure 6 is a side view of the control device 12 of the scope 10 of Figure 1, showing puller wires 70A and 70B for the scope shaft 26 of the scope 10. Figure 7 is a perspective view of the distal tip 72 of the scope shaft 26 of the scope 10 of Figure 6. Figures 6 and 7 are considered simultaneously.

[0032] As discussed, the catheter assembly 14 (FIG. 1) may be connected to the working channel receptacle 34 and may extend along an axis AA. The scope shaft 26 may extend from the housing 74 of the control unit 12 along a central longitudinal axis AB. The axes AA and AB may thereby be concentric along the portion of the elongated catheter body 36 that extends into the scope shaft 26.

[0033] Distal tip 72 can be rotated about axis AB by rotation of controller 12. Distal tip 72 can be articulated, such as bent, along axis AB in the plane indicated by arrow 75 ( FIG. 7 ). Specifically, pull wire 70A and pull wire 70B can be connected to lever 32 ( FIG. 1 ) via gear 76, shown externally. Thus, movement of lever 32 can rotate gear 76 in the direction of arrow 78, resulting in movement of distal tip 72 in the direction of arrow 75. In an example, movement of lever 32 to the left in FIG. 6 can cause pull wire 70A to be pulled at distal tip 72, resulting in upward movement of distal tip 72 in FIG. 7 , and movement of lever 32 to the right in FIG. 6 can cause pull wire 70B to be pulled at distal tip 72, resulting in downward movement of distal tip 72 in FIG. 7 . To facilitate movement of the puller wires 70A and 70B within the control unit 12, the puller wires 70A and 70B may be disposed within sheaths 80A and 80B, respectively. The sheaths 80A and 80B may be fixedly mounted to the housing 74 of the control unit 12. The sheaths 80A and 80B may help maintain the puller wires 70A and 70B in alignment with the working channel 84 of the scope shaft 26. The sheaths 80A and 80B may apply additional compression to the puller wires 70A and 70B to help maintain the distal tip 72 in the orientation applied by the lever 32. The sheaths 80A and 80B may be coupled to the housing 74 via supports 82A and 82B, respectively. The supports 82A and 82B may support a substantial majority of the sheaths 80A and 80B, particularly along the central portions of the sheaths 80A and 80B. The support portions 82A and 82B can immobilize the sheaths 80A and 80B within the housing 74, and can prevent the sheaths 80A and 80B from bending.

[0034] Working channel 84 of scope shaft 26 may be connected to working channel receiver 34 by tubing 86. Specifically, scope shaft 26 may extend into anchoring portion 88 such that working channel 84 of scope shaft 26 is within housing 74. Thus, tubing 86 may connect working channel 84 with working channel receiver 34. Working channel receiver 34 may be connected to connector 16 of catheter assembly 14, as shown in FIG. 1 . Working channel receiver 34 may be positioned proximate to anchoring portion 88. Lever 32 and button 30B may be positioned in control portion 90 at the end of housing 74 opposite anchoring portion 88.

[0035] For the configuration of FIG. 6 , controller 12 may be positioned so that proximal portions of puller wires 70A and 70B extend from gear 76 and control portion 90 along axis AC. Distal portions of puller wires 70A and 70B may extend along axis AD, which may coincide with axis AB or with scope shaft 26 at anchoring portion 88. Axis AC may be positioned at an angle from approximately 180 degrees to approximately 150 degrees, thereby allowing working channel 84 to be axially aligned with gear 76 or have a line of sight with gear 76. Sheaths 80A and 80B are thus fixed in position to guide puller wires 70A and 70B from gear 76 to working channel 84. It is not practical to include a kink in sheaths 80A and 80B, e.g., a bend greater than approximately 30 degrees, because this may result in stress within the sheaths when puller wires 70A and 70B are under tension. Additionally, adjusting the position between lever 32 and working channel 84 is not possible as this would cause pull wires 70A and 70B to become overstretched or slack.

[0036] 1, the handle 22 for the catheter assembly 14 can be positioned a variable distance from the working channel receiver 34, depending on the state of the extension piece 18. Regardless of the length of the extension piece 18, the handle 22 can be positioned above or proximal to the lever 32, offset laterally from the lever 32, or a distance away from the lever 32. Additionally, the lever 32 can be positioned a fixed distance from the working channel receiver 34. Operation of the scope 10 and catheter assembly 14 can thereby be cumbersome due to the positioning of the controls 12 away from the handle 22.

[0037] In the present disclosure, controls for scopes, such as control device 12, can be configured to have: 1) actuation mechanisms, such as buttons and levers, that are adjustably positionable relative to one another; 2) control device housings that have portions that are adjustably positionable relative to one another [FIGS. 8A-10B]; 3) control device housings that can have anchoring and control portions that are bent, curved, twisted, or otherwise configured so that the gears for the pull wires are not aligned with or have a line of sight to the working channel opening of the scope shaft [FIG. 12]; and 4) control device housings that can be separated into two distinct portions that are positioned apart from one another or that can have a flexible handle portion between them [FIG. 13]. To facilitate such configurations, the controller housing of the present disclosure may include pull wire tensioners that cause the pull wires to bend, curve, twist, pull, push, or otherwise include irregular or varying paths to connect non-aligned, non-connected, or adjustable portions of the controller housing while maintaining tension in the pull wires to eliminate slack and provide other benefits as described herein.

[0038] Figure 8A is a perspective view of the adjustable control device 100 of the present disclosure in a retracted state. Figure 8B is a perspective view of the adjustable control device 100 of Figure 8A in an extended state. Figures 8A and 8B are considered simultaneously.

[0039] Adjustable control device 100 may include anchor component 102A and control device component 102B. Anchoring component 102A may include catch 104, base 106, working channel opening 108, stop 110, slider post 112, and internal passageway 113 (FIGS. 9A and 9B). Control device component 102B may include head 114, slider element 116, lever opening 118, button opening 120, end 122, and internal passageway 124 (FIGS. 9A and 9B).

[0040] Controller component 102B can be configured to move relative to anchor component 102A. In the illustrated example, controller component 102B can slide axially relative to anchor component 102A along axis AE, thereby adjusting distance D2 between working channel opening 108 and lever opening 118. For example, a user can move controller component 102B away from anchor component 102A to increase distance D2 so that head 114 can be positioned comfortably for use.

[0041] The fastener 104 can be coupled to an elongated, flexible shaft configured for insertion into a patient's anatomy. The fastener 104 can include a threaded engagement or a lip, flange, channel, or other feature to which a component of the scope shaft can mate. The base 106 can include a structural component capable of supporting other portions of the adjustable controller 100, including the working channel opening 108 and the controller component 102B. Similar to that shown in FIG. 1 , the working channel opening 108 and the base 106 can be configured to support other instruments in a fixed or operative relationship relative to the adjustable controller 100. A sliding post 112 can extend from the base 106 at a stop 110. The sliding post 112 can include an elongated portion of the anchor component 102A along which the controller component 102B can slide. In the illustrated example, the sliding post 112 can include a reduced diameter portion relative to the base 106. Stop 110 may be configured to abut controller component 102B in a fully collapsed position when D2 is smallest, as shown in FIG. 8A.

[0042] Head 114 may include structural components for receiving control actuators for adjustable control device 100. For example, lever opening 118 may receive a pull wire lever similar to lever 32 (FIG. 1), and button opening 120 may receive a button similar to button 30B (FIG. 1) to control a function of the scope, such as imaging or irrigation capabilities. Head 114 may be shaped to allow a user to grip control device component 102B to operate the lever and button. Slider element 116 may extend from head 114 for engagement with tether component 102A. Slider element 116 may include an elongated tube configured to receive slide post 112. In the illustrated example, slide element 116 may include a reduced diameter portion relative to head 114. End 122 of slide element 116 may be configured to engage stop 110 of tether component 102A at interface 125. Slider element 116 may be configured to provide one or more locations for a user to place fingers on the hand operating the actuator at lever opening 118 and button opening 120 as well as on the other hand.

[0043] The slide post 112 and slide element 116 may comprise hollow tubular bodies through which a pull wire can extend. For example, the pull wire can extend from a gear connected to the lever at the lever opening 118 to the scope shaft connected to the fastener 104. The slide post 112 may have an outer peripheral shape that is complementary to the inner peripheral shape of the slide element 116. In the illustrated example of FIGS. 8A and 8B, the slide post 112 and slide element 116 may have a circular cross-sectional shape. However, in other examples, other cross-sectional shapes may be used, as shown and discussed with reference to FIG. 11.

[0044] Figure 9A is a partially cutaway perspective view of the adjustable control device 100 of Figure 8B showing the slide post 112 and slide element 116 configured to deploy the control device component 102B away from the anchor component 102A. Figure 9B is an enlarged view of the slide post 112 and slide element 116 of Figure 9A. The slide post 112 can fit into an internal passage 124. The slide post 112 can include a channel 126, and the internal passage 124 can include a flange 128 that can be positioned within the channel 126. Figures 9A and 9B are considered simultaneously.

[0045] As discussed, the slide post 112 and the slide element 116 may be configured to have a circular cross-sectional profile, thereby permitting relative rotation between the slide post 112 and the slide element 116 along the axis AE ( FIG. 8A ). However, anti-rotation features may be included to maintain the relative rotational position of the slide post 112 and the slide element 116. In an example, the channel 126 may extend parallel to the axis AE along at least a portion of the length of the slide post 112. Similarly, the flange 128 may extend parallel to the axis AE along at least a portion of the length of the slide element 116. The flange 128 may ride into the channel 126 when the anchor component 102A and the control component 102B are assembled. The flange 128 may allow the control component 102B to move axially relative to the anchor component 102A. However, flange 128 can prevent or inhibit, or at least limit, the amount of relative rotation that control device component 102B can undergo with respect to anchor component 102A. In an example, flange 128 can be approximately the same width as channel 126 in a circumferential direction relative to axis AE, so that circumferential rotation is prevented while still allowing axial movement. In another example, channel 126 can be provided in slider element 116 and flange 128 can be included in slider post 112.

[0046] Figure 10A is a cross-sectional view of the adjustable control device 200 of the present disclosure including the tension wire tensioner 202A and tension wire tensioner 202B of the present disclosure, which accommodate a variable distance between the anchoring component 204A and the control device component 204B of the adjustable control device 200. Figure 10B is a cross-sectional view of the adjustable control device 200 of Figure 10A, with the control device component 204B extended from the anchoring component 204A. Figures 10A and 10B are considered simultaneously.

[0047] Tether piece 204A may include a base 208, a working channel opening 210, a slider post 212, and an internal passageway 214. Controller piece 204B may include a head 216, a slider 218, a button 220, a lever 222, and an internal passageway 224. In an example, adjustable controller 200 may be configured similarly to controller 12 of FIG. 6, with housing 74 divided into tether piece 204A and controller piece 204B. In an example, tether piece 204A and controller piece 204B may be configured similarly to tether piece 102A and controller piece 102B of FIGS. 8A-9B.

[0048] A cap 230 may be connected to the base 208 to attach the scope shaft 234 to the tether 204A. A strain relief 232 may be connected to the cap 230 via a flange 233. The strain relief may comprise a flexible tube to limit the flexure of the scope shaft 234, thereby reducing strain on the scope shaft 234. In an example, the strain relief 232 may extend through an opening in the cap 230, and the flange 233 may prevent the strain relief from passing through the cap 230. The cap 230 may be threaded onto the base 208. The scope shaft 234 may enter the flange 233 and pass through the strain relief 232. The scope shaft 234 may be crimped into the opening in the base 208 using a swage 235. However, the scope shaft 234 may be connected to the tether 204A in a variety of ways.

[0049] Scope shaft 234 may extend from swage section 235 through cap 230 and strain relief 232 to a distal end portion, similar to distal tip 72 of scope shaft 26 shown in FIG. 7. Pull wires 236A and 236B may extend to the distal portion of scope shaft 234 to guide bending or curvature of the distal tip portion. Pull wires 236A and 236B may extend from scope shaft 234 within internal passage 214 of anchoring piece 204A. Pull wires 236A and 236B may continue to a gear (shown here and similar to gear 76 in FIG. 6) in head 216 that connects to lever 222. Note that in an example, pull wires 236A and 236B may be connected to wire portion 240 via connectors 242A and 242B, respectively, for manufacturing purposes. Lever 222 can thereby be actuated to pull on each of pull wires 236A and 236B. With reference to Figure 7, movement of lever 32 to the left in Figure 10A can cause pull wire 236A to be pulled at distal tip 72, resulting in upward movement of distal tip 72 in Figure 7, and movement of lever 32 to the right in Figure 10A can cause pull wire 236B to be pulled at distal tip 72, resulting in downward movement of distal tip 72 in Figure 7.

[0050] Pull wire 236A can extend to wire tensioner 202A, and pull wire 236B can extend to wire tensioner 202B. Wire tensioner 202A can be connected to sliding post 212 via tether 244A, and wire tensioner 202B can be connected to sliding post 212 via tether 244B. Wire tensioner 202A can be connected to sliding portion 218 via tether 246A, and wire tensioner 202B can be connected to sliding portion 218 via tether 246B. Wire tensioner 202A and wire tensioner 202B can each include a component or device for taking up slack and providing tension to pull wire 236A and 236B, respectively. Wire tensioner 202A and wire tensioner 202B can be used to accommodate changes in the distance between portions or components of adjustable control device 200. In the illustrated example, adjustable controller 200 may include anchoring component 204A and controller component 204B that can be translated away from anchoring component 204A along axis AF, thereby moving head 216 and lever 222 away from base 208 and working channel opening 210. However, in other examples, lever 222 can be configured to move relative to working channel opening 210 without allowing controller component 204B to move relative to anchoring component 204A. Thus, in various configurations, lever 222 can be positioned a distance D3 away from working channel opening 210. In FIG. 10B , distance D3 can be increased relative to distance D3 in FIG. 10A by translating, such as sliding, controller component 204B away from anchoring component 204A.

[0051] As discussed herein, in conventional scope control devices with pull wires, the pull wire actuator cannot be moved away from where the pull wire enters the scope shaft because there is no slack in the pull wire, and slack cannot be introduced without impairing the ability of the pull wire actuator. In the present disclosure, adjustable control device 200 can include pull wire tensioners 202A and 202B to maintain tension in pull wires 236A and 236B, respectively, which can introduce slack into pull wires 236A and 236B, such as a length beyond that required to connect two points via the shortest path, to facilitate movement of lever 222 away from base 208. The tension applied by pull wire tensioners 202A and 202B can eliminate play or slack in the movement of lever 222 before the slack begins to actually pull pull wires 236A and 236B. In other words, pull wire tensioners 202A and 202B allow lever 222 to provide immediate responsiveness when applying tension to pull wires 236A and 236B, despite excess length of pull wires 236A and 236B.

[0052] A first end of tension wire tensioner 202A can be connected to anchor component 204A at anchor portion 244A, and a second end of tension wire tensioner 202A can be connected to controller component 204B at anchor portion 246A. A first end of tension wire tensioner 202B can be connected to anchor component 204A at anchor portion 244B, and a second end of tension wire tensioner 202B can be connected to controller component 204B at anchor portion 246B. Tether component 204A can include cutouts or windows 248 to move anchor portions 246A and 246B closer to anchor portions 244A and 244B within anchor component 204A. Tether portions 244A, 244B, 246A, and 246B can include clip or U-shaped bodies into which tension wire tensioners 202A and 202B can fit. Pull wire tensioners 202A and 202B may be attached or glued to tethers 244A, 244B, 246A, and 246B to prevent the ends of pull wire tensioners 202A and 202B from moving relative to their respective handle pieces. However, pull wire tensioners 202A and 202B may be unsupported or free-floating between tethers 244A and 244B and tethers 246A and 246B to allow for stretching, straightening, or flattening of any curvature in pull wire tensioners 202A and 202B.

[0053] Pull wire tensioner 202A and pull wire tensioner 202B may comprise a ferrule or a curved elongated tube through which pull wire 236A and pull wire 236B, respectively, can extend. The elongated tube may be sufficiently rigid so that pulling on pull wires 236A and 236B does not deform the elongated tube, such as bending or straightening it, but may be sufficiently flexible so that pulling control device component 204B away from anchor component 204A can bend the elongated tube into a straighter or less curved body. In an example, pull wire tensioners 202A and 202B may be fabricated from plastic or metal. In an example, pull wire tensioners 202A and 202B may each include one long bend between the anchors. In an example, pull wire tensioners 202A and 202B may be wavy, such as having multiple up and down bends between the anchors. The absolute distance between the first end of tension wire tensioner 202A at tether portion 244A and the second end of tension wire tensioner 202A at tether portion 246A can thereby be increased as the undulations become weaker or less curved. In other words, the length along the central axis of tension wire tensioner 202A and tension wire tensioner 202B can be longer than the distance between tether portions 244A and 244B and 246A and 246B, respectively, in the retracted state, but the length along the central axis of tension wire tensioner 202A and 202B can be increased to approach or equal the distance between tether portions 244A and 244B and 246A and 246B in the extended state. The inherent stiffness of tension wire tensioner 202A and tension wire tensioner 202B can maintain tension in pull wires 236A and 236B to maintain the responsiveness of lever 222. The curved or wavy nature of the pull wire tensioners 202A and 202B can change or increase the length of the adjustable control or can change or increase the distance between the working channel opening 210 and the lever 222.However, the pull wire tensioners 202A and 202B can additionally be used to displace or decouple the control device component 204B from the anchor component 204A, as discussed with reference to Figures 12 and 13, respectively.

[0054] Figure 11 is a cross-sectional view of the adjustable control device 200 of Figure 10A, showing an irregular cross-sectional shape to prevent rotation. Slide post 212 of anchoring component 204A can be mounted within slide portion 218 of control device component 204B. In the example of Figure 11, slide post 212 and slide portion 218 can have hollow triangular cross-sectional profiles. For example, slide post 212 can include first panel 250A, second panel 250B, and third panel 250C, and slide portion 218 can include first panel 252A, second panel 252B, and third panel 252C. First panel 250A, second panel 250B, and third panel 250C of slide post 212 can fit within internal passage 224 of slide portion 218, and internal passage 214 of slide post 212 can remain free to accommodate pull wires 236A and 236B and pull wire tensioners 202A and 202B, which are not shown in FIG. 11 for simplicity. The irregular cross-sectional shapes of slide post 212 and slide portion 218 can prevent relative rotation between slide post 212 and slide portion 218, thereby allowing the adjustable control to maintain the relative rotational positioning of various features, such as working channel opening 210 and lever 222.

[0055] In additional examples of the present disclosure, the sliding post 212 and sliding portion 218 can have regular cross-sectional profiles, such as circles, to allow relative rotation therebetween. In such examples, the adjustable control device 200 can include locking features that can be selectively activated by the user to prevent movement of the rotational position at a desired location. For example, the sliding post 212 can include a spring-loaded detent, and the sliding portion 218 can include multiple holes at different circumferential locations relative to the central axis AF.

[0056] 12 is a cross-sectional view of a control device 300 of the present disclosure having a handle 302 with non-aligned tether portions 304A and control device portions 304B between which pull wire tensioners 306A and 306B of the present disclosure extend. The control device 300 may be configured similar to the control device 200 of FIGS. 10A and 10B, with the tether portion 304A connected to the control device portion 304B by a fixed intermediate portion 314, instead of the tether portion 304A being slidably connected to the control device portion 204B. As such, the control device 300 is provided with similar reference numerals as the control device 200, but with different series numbers, such as numbers in the 300 series rather than the 200 series.

[0057] Control device 300 may include a base 308, a working channel opening 310, a middle portion 314, a head 316, a button 320, a lever 322, an internal passageway 324, a strain relief 332, and a flange 333. Control device 300 may further include pull wires 336A and 336B that may be inserted into pull wire tensioners 302A and 302B, respectively. Pull wire tensioners 302A and 302B may be connected to tethers 344A and 344B and 346A and 346B, respectively.

[0058] Handle 302 can include a tether portion 304A and a controller portion 304B, which can be connected by an intermediate portion 314. Tether portion 304A can extend along axis AG, controller portion 304B can extend along axis AH, and intermediate portion 314 can extend along axis AI. In the illustrated example, axis AG can extend parallel to axis AH, and axis AI is perpendicular to axes AG and AH. However, in other examples, axes AG and AH can be oblique to each other, and axes AG and AH can be oblique to axis AI. In examples, the angles between axes AG, AH, and AI can be such that the opening of scope shaft 334 and working channel opening 310 do not have a line of sight with the gears for lever 322 in controller 300, such as through internal passage 324. For example, axes AG and AI can be disposed at an angle greater than approximately 30 degrees, and axes AI and AH can be disposed at an angle greater than approximately 30 degrees. The pull wire tensioners 306A and 306B can be used to thread the pull wires 336A and 336B through the middle portion 314 to additionally prevent the pull wires 336A and 336B from binding against the surfaces of the base 308, middle portion 314, and head 316, while maintaining tension in the pull wires 336A and 336B to cause the lever 322 to responsively pull on the pull wires 336A and 336B.

[0059] Tethers 344A, 344B and 346A, 346B can hold the ends of pull wire tensioners 302A, 302B fixed, while pull wire tensioners 302A, 302B can remain floating between the tethers. The ends of pull wire tensioners 302A, 302B can be oriented to point the working channels toward scope shaft 334 and lever 322 to facilitate smooth movement of pull wires 336A, 336B. In an example, pull wire tensioners 302A, 302B can follow the general paths of axes AH, AI, and AG, while simultaneously undulating along such paths. The pull wire tensioners 302A and 302B can take up excess length or slack in the pull wires 336A and 336B to extend between the scope shaft 334 and the lever 322 without binding the pull wires 336A and 336B along parts such as the corners of the base 308, the middle section 314, and the head 316.

[0060] 13 is a schematic perspective view of the control device 400 of the present disclosure with the tether component 404A disconnected from the control device component 404B. A pull wire tensioner of the present disclosure can extend within the tube 450 between the tether component 404A and the control device component 404B.

[0061] 10A and 10B, with tether component 404A being separate from controller component 404B instead of slidably connected to controller component 204B. Tether component 404A may include a base 408 and a working channel opening 410. Controller component 404B may include a head 416 and a knob 422. Tether component 404A may be connected to controller component 404B by tubing 450. Head 416 may include cables 452 for connecting to electronics, a surgical system tower, a generator, imaging equipment, and the like.

[0062] The control device 400 may be connected to other medical devices or scopes, such as a duodenoscope 454. The duodenoscope 454 may include a shaft 456 that may be inserted into a patient's anatomy and may include a working channel through which the shaft for the control device 400 may be inserted. Thus, a tool or instrument, such as a catheter, may be inserted into the working channel opening 410 for insertion into the shaft for the control device 400 positioned inside the shaft 456. A knob 458 on the duodenoscope 454 may be operated to bend or curve the shaft 456. A knob 422 may be operated to bend or curve the distal tip of the shaft of the control device 400 that protrudes from the shaft 456.

[0063] The base 408 can be coupled to a handle 460 of the duodenoscope 454. In an example, the base 408 can include a cap that can be threadably engaged with an access portion of the handle 460 of the duodenoscope 454. Thus, the base 408 can provide a direct entry path to the handle 460 for the tube 450 and the working channel opening 410. However, the head 416 can be positioned remotely from the base 408, thereby allowing it to be positioned in a more convenient or ergonomic location, as opposed to simply extending from the base 408. The head can include a hollow body to hold the operating components for the control device 400. In an example, the head 416 can be held by the operator. In the illustrated example, the base 408 can be attached to the handle 460. For example, the base 408 can include a U-shaped clip to snap onto a distal portion of the handle 460. Thus, the pull wire can extend from a gear attached to knob 422 in head 416 through tube 450 to base 408. To facilitate separation of head 416 from base 408, tube 450 can be provided with a pull wire tensioner of the present disclosure. Thus, a tensioner tether can be attached to head 416 and base 408, and a tensioner tube or ferrule as disclosed herein can extend between head 416 and base 408 within tube 450. The tensioner tube or ferrule can be curved or wavy to take up slack in the pull wire. However, the curve or wavy shape of the tensioner tube or ferrule can flex to move head 416 to different positions relative to base 408. Thus, controller 400 can be similar to controller 300, but with tube 450 replacing mid-section 314. In a further example of the present disclosure shown in FIG. 12, the middle portion 314 may be flexible to allow for variable positioning of the head portion 316 relative to the base portion 308 .

[0064] In view of the above disclosure, the present disclosure can provide systems, devices, and methods for ergonomic control for endoscopes and other scopes. Specifically, the present disclosure provides a scope control device having an adjustably positionable control element or control actuator, whereby the position between two actuators or the position between an actuator and a connection feature for an auxiliary scope can be adjusted to provide more ergonomic and user-friendly positioning. The present disclosure can also provide systems, devices, and methods for a pull wire that can be tensioned without line of sight between the control actuator and the working channel, whereby the handpiece of the scope control device can separate the control actuator and working channel into offset, movable, or separate handpiece elements. [Example]

[0065] Example 1 is a control device for an endoscope comprising a handle, a working channel opening connected to the handle at a first location, a control actuator connected to the handle at a second location, a first pull wire extending from the control actuator in the handle to the working channel opening, and a first pull wire tensioner through which the first pull wire extends, the first pull wire tensioner configured to remove slack from the first pull wire between the first location and the second location.

[0066] In Example 2, the subject matter of Example 1 optionally includes that the control actuator is configured to pull a first pull wire to bend an insertion shaft extending from the handle, the insertion shaft including a working channel connected to the working channel opening.

[0067] In Example 3, the subject matter of Example 2 optionally includes wherein the first pull wire tensioner comprises a bent tube.

[0068] In Example 4, the subject matter of Example 3 optionally includes the first pull wire tensioner being fabricated from a rigid material and flexible in the curvature of the bent tube.

[0069] In Example 5, the subject matter of one or more of Examples 3-4 optionally includes that the first pull wire tensioner comprises a first anchor portion secured to the handle proximate the working channel opening and a second anchor portion secured to the handle proximate the control actuator.

[0070] In Example 6, the subject matter of Example 5 optionally includes the first pull wire tensioner floating within the handle along a majority of the length of the first pull wire tensioner.

[0071] In Example 7, the subject matter of one or more of Examples 5-6 optionally includes wherein a length along a central axis of the first pull wire tensioner between the first anchoring portion and the second anchoring portion is greater than a linear distance between the first anchoring portion and the second anchoring portion.

[0072] In Example 8, the subject matter of one or more of Examples 5-7 optionally includes that the bent pipe is wavy.

[0073] In Example 9, the subject matter of one or more of Examples 5-8 optionally includes the handle comprising a twist between the first tether portion and the second tether portion.

[0074] In Example 10, the subject matter of Example 9 optionally includes the handle comprising a bend between the first location and the second location such that the first pull wire turns at least 30 degrees.

[0075] In Example 11, the subject matter of one or more of Examples 5-10 optionally includes, wherein the handle comprises a tether component connected to the working channel opening and the first tether component, and a control component connected to the control actuator and the second tether component.

[0076] In Example 12, the subject matter of Example 11 optionally includes the anchoring component and the control component not being connected to one another and having a first pull wire tensioner extending therebetween.

[0077] In Example 13, the subject matter of Example 12 optionally includes, wherein the anchoring component and the control component are connected by a handheld control device of another endoscope.

[0078] In Example 14, the subject matter of one or more of Examples 11-13 optionally includes the control device being configured to enable the control actuator to move from a first position to a second position relative to the working channel opening, and the first pull wire tensioner being configured to tension the first pull wire at the first location and the second location.

[0079] In Example 15, the subject matter of Example 14 optionally includes the anchoring component telescoping with the control component.

[0080] In Example 16, the subject matter of Example 15 optionally includes, wherein the handle comprises an anti-rotation feature to prevent rotation between the anchoring component and the control component.

[0081] In Example 17, the subject matter of Example 16 optionally includes that the anchoring component comprises a base in which the working channel opening is located and a slider extending from the base, and the control component comprises a tube into which the slider extends and a head on which the control actuator is mounted.

[0082] In Example 18, the subject matter of Example 17 optionally includes, wherein the anti-rotation feature comprises a slider and a cross-sectional shape of the tube that prevents rotation.

[0083] In Example 19, the subject matter of one or more of Examples 11-18 optionally includes, wherein the tether component and the control component are connected via a flexible handle portion.

[0084] In Example 20, the subject matter of one or more of Examples 1-19 optionally includes wherein the control actuator comprises a lever connected to the first pull wire and the second pull wire.

[0085] Various notes The above detailed description includes references to the accompanying drawings, which form a part of the detailed description. The drawings show, by way of illustration, specific embodiments in which the invention may be practiced. These embodiments are also referred to herein as "examples." Such examples may include elements in addition to those shown or described. However, the inventors also contemplate examples in which only those elements shown or described are provided. Furthermore, the inventors also contemplate examples (or one or more aspects thereof) using any combination or permutation of those elements shown or described, either with respect to the specific example (or one or more aspects thereof) or with respect to other examples (or one or more aspects thereof) shown or described herein.

[0086] In the event of a conflicting usage between this document and any document incorporated by reference, the usage in this document controls.

[0087] The terms "a" and "an" are used herein to include one or more, as is common in patent documents, regardless of any other instance or use of "at least one" or "one or more." Unless otherwise noted herein, the term "or" is used to refer inclusively, or such that "A or B" includes "A but not B," "B but not A," and "A and B." The terms "including" and "in which" are used herein as the plain English equivalents of "comprising" and "wherein," respectively. Also, in the appended claims, the terms "including" and "comprising" are open-ended, meaning that systems, devices, articles, compositions, formulations, or processes that include elements in addition to the elements listed after such terms in a claim are still deemed to be within the scope of that claim. Moreover, in the appended claims, the terms "first," "second," and "third" are used merely as labels and are not intended to impose numerical requirements on their objects.

[0088] The example methods described herein may be implemented, at least in part, by a machine or computer. Some examples may include a computer-readable medium or machine-readable medium encoded with instructions operable to configure an electronic device to perform a method such as that described in the examples. An implementation of such a method may include code, such as microcode, assembly language code, or high-level language code. Such code may include computer-readable instructions for performing various methods. The code may form part of a computer program product. Further, in examples, the code may be stored on one or more volatile, non-transitory, or non-volatile tangible computer-readable media, such as during execution or at other times. Examples of these tangible computer-readable media may include, but are not limited to, hard disks, removable magnetic disks, removable optical disks (e.g., compact disks and digital video disks), magnetic cassettes, memory cards or sticks, random access memory (RAM), and read-only memory (ROM).

[0089] The foregoing description is intended to be illustrative, not limiting. For example, the above examples (or one or more aspects thereof) may be used in combination with each other. Other embodiments may be utilized by those of ordinary skill in the art upon review of the above description. The Abstract is provided to comply with 37 CFR §1.72(b) to allow the reader to quickly ascertain the nature of the technical disclosure. The Abstract is submitted with the understanding that it will not be used to interpret or limit the scope or meaning of the claims. Also, in the foregoing Detailed Description, various features may be grouped together to streamline the disclosure. This should not be construed as intending that an unclaimed disclosed feature is essential to any claim. Rather, inventive subject matter may lie in less than all features of a particular disclosed embodiment. Accordingly, the appended claims are contemplated as each claim standing on its own as a separate embodiment, incorporated herein in the Detailed Description as an example or embodiment, and it is contemplated that such embodiments can be combined with each other in various combinations or permutations. The scope of the invention should be determined with reference to the appended claims, along with the full scope of equivalents to which such claims are entitled. [Explanation of symbols]

[0090] 10 Scope 12 Control device 14 Catheter assembly 16 Coupler 18 Extension parts 20 Rotating member 22 Toride 24 Proximal grip 26 Scope shaft 28A, 28B input cables 30A, 30B buttons 32 Lever 33 Distal end region 34 Working channel receiving part 35 Movement direction of handle 22 36 Long, thin catheter body 37 Hub 38 Rotational direction of elongated catheter body 36 40 Functional parts 41 Multi-element Planar Ultrasound Array 42 Acoustic Lens 43, 44 elements 45 Electronic Package 46 Electromagnetic Coil 47 Aperture 48 Electromagnetic Coil 49 Tools 52 Patient Interface Module, PIM 54 QUS Process 70A, 70B Pull Wire 72 Distal tip 74 Case 75 plane, direction of movement of distal tip 72 76 Gears 78 Rotation direction of gear 76 80A, 80B sheath 82A, 82B support part 84 working channels 86 tube 88 Mooring section 90 Control section 100 Adjustable Control Device 102A Mooring parts 102B Control device parts 104 Fasteners 106 Base 108 Working channel opening 110 Stop part 112 Sliding column 113 Internal passage 114 Head 116 Sliding element 118 Lever opening 120 Button Opening 122 End 124 Internal passage 126 channels 128 flange 200 Adjustable Control Device 202A Pull Wire Tensioner 202B Pull Wire Tensioner 204A Mooring parts 204B Control device parts 216 Head 218 Sliding part 220 Button 222 Lever 224 Internal passage 230 Cap 232 Distortion reduction section 233 Flange 235 Upset section 236A, 236B Pull Wire Wire section 240 242A, 242B connector 244A, 244B mooring section 246A, 246B mooring section 248 Cutouts, windows 250A First Panel 250B Second Panel 250C Third Panel 252A First Panel 252B Second Panel 252C Third Panel 300 control device 302 Toride 302A, 302B Pull Wire Tensioner 304A Mooring section 304B Control device part 306A, 306B Pull Wire Tensioner 308 Base 310 Working channel opening 314 Middle part 316 Head 320 Button 322 Lever 324 Internal passage 332 Distortion reduction section 333 flange 334 Scope Shaft 336A, 336B Pull Wire 344A, 344B, 346A, 346B moorings 400 control device 404A Mooring parts 404B Control device parts 408 Base 410 Working channel opening 416 Head 422 Nobu 450 tube 452 Cable 454 Duodenoscope 456 Shaft 458 Nobu 460 Toride AA, AB central longitudinal axis AC, AD, AE, AF, AG, AH, AI axis D1: Distance that the proximal gripping portion 24 can move D2 - distance between working channel opening 108 and lever opening 118 D3 Distance from working channel opening 210 to lever 222

Claims

1. 1. A control device for an endoscope, comprising: With handle, a working channel opening connected to the handle at a first location; a control actuator connected to the handle at a second location; a first pull wire extending from the first location to the second location within the handle; a first tension wire tensioner through which the first tension wire extends; Equipped with the first pull wire tensioner is configured to remove slack from the first pull wire between the first location and the second location; the handle is configured to be adjustable in distance between the first location and the second location; the control actuator is configured to pull the first pull wire to bend an insertion shaft extending from the handle, the insertion shaft including a working channel connected to the working channel opening; The first pull wire tensioner comprises: a first tether secured to the handle adjacent the working channel opening; a second tether secured to the handle adjacent the control actuator; Equipped with The first mooring portion is configured to move with the first location and the second mooring portion is configured to move with the second location.

2. The control device of claim 1 , wherein the first pull wire tensioner comprises a bent tube.

3. The control device of claim 2 , wherein the first pull wire tensioner is fabricated from a rigid material and is flexible in the curve of the bent tube.

4. The control device of claim 1 , wherein the first pull wire tensioner floats within the handle along a majority of the length of the first pull wire tensioner.

5. 2. The control device of claim 1, wherein a length along a central axis of the first pull wire tensioner between the first tether portion and the second tether portion is longer than a linear distance between the first tether portion and the second tether portion.

6. The control device of claim 1 , wherein the bent tube is wavy.

7. The control device of claim 1 , wherein the handle includes a bend between the first location and the second location such that the first pull wire deflects at least 30 degrees.

8. The handle is an anchoring piece connected to the working channel opening and the first anchoring portion; a control component connected to the control actuator and the second anchoring portion; The control device of claim 1 , comprising:

9. The control device of claim 8 , wherein the tether component and the control component are not connected to one another and the first pull wire tensioner extends therebetween.

10. the control device is configured to enable the control actuator to move from a first position to a second position relative to the working channel opening; The control device of claim 8 , wherein the first pull wire tensioner is configured to tension the first pull wire at the first location and the second location.

11. The control device of claim 10 , wherein the control component comprises a slider element, the anchor component comprises a slider post configured to be received in the slider element, and the anchor component telescopes with the control component.

12. The control device of claim 11 , wherein the handle includes an anti-rotation feature to prevent rotation between the anchoring component and the control component.

13. The mooring part is a base in which the working channel opening is disposed; a slider extending from the base; Equipped with The control component is a tube into which the slider extends; a head portion on which the control actuator is mounted; The control device of claim 12 , comprising:

14. The control device of claim 13 , wherein the anti-rotation feature comprises a cross-sectional shape of the slider and the tube that prevents rotation.

15. The control device of claim 1 , wherein the control actuator comprises a lever connected to the first pull wire and the second pull wire.

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