Pull wire tensioning mechanism for endoscopes

Abstract

To provide pull wire tensioning mechanisms for endoscopes.SOLUTION: An endoscope comprises a handpiece housing, an elongate flexible shaft extending from the handpiece housing, a pull wire extending from the handpiece housing into the elongate flexible shaft, and a tensioning mechanism configured to adjust tension in the pull wire. A method for adjusting tension in a pull wire of a controller for an endoscope comprises preparing an endoscope for use before a procedure, adjusting tension in a pull wire for deflecting a flexible elongate shaft of the endoscope to reduce the knob dwell, and performing an endoscopic procedure with the endoscope.SELECTED DRAWING: Figure 2

Description

Technical Field

[0001] Priority Claim This application claims the benefit of priority of U.S. Provisional Patent Application No. 63 / 378,406, filed on October 5, 2022, the content of which is incorporated herein by reference in its entirety.

[0002] The present disclosure generally relates to a medical device including an elongate body configured to be inserted into an incision or an opening in a patient's anatomical structure to provide a diagnostic or therapeutic action.

[0003] More specifically, the present disclosure relates to a medical device (such as an endoscope) having a controller connected to the elongate body to adjust a pull wire extending through the elongate body.

Background Art

[0004] Endoscopes can be used to 1) provide a passage for other devices (such as therapeutic devices or tissue collection devices) towards various anatomical parts, and 2) for imaging one or more of such anatomical parts. Such anatomical parts can include the gastrointestinal tract (such as the esophagus, stomach, duodenum, pancreaticobiliary duct, intestine, colon, etc.), the renal region (such as the kidney, ureter, bladder, urethra), and other internal organs (such as the genital system, paranasal sinuses, submucosal region, airway), etc.

[0005] Conventional endoscopes can be involved in various clinical procedures, such as irradiating, imaging, detecting, and diagnosing one or more disease states, providing fluid delivery (such as saline or other formulated solutions through a fluid channel) towards an anatomical region, providing a passage for one or more therapeutic devices (such as through a working channel) for sampling or treating an anatomical region, and providing a suction passage for collecting fluid (such as saline or other formulated solutions), etc.

[0006] In conventional endoscopy, the distal portion of the endoscope can be configured to support and orient therapeutic devices, for example, by using an elevator. In some systems, two endoscopes can be configured to work together, with the assistance of an elevator, so that the first endoscope guides the second endoscope being inserted into it. Such systems can be useful when guiding the endoscope to anatomical locations in the body that are difficult to reach. For example, some anatomical locations can only be accessed by the endoscope after insertion via a roundabout route. For example, duodenal endoscopy procedures (e.g., endoscopic retrograde cholangiopancreatography, hereafter referred to as "ERCP") involve the use of an auxiliary scope (also called a daughter scope or cholangioscope) that can be advanced through the working channel of the main scope (also called a mother scope or duodenoscope). Furthermore, another device (e.g., a therapeutic device) (such as a tissue retrieval device used for biopsy) can be inserted into the auxiliary scope. Therefore, the treatment device can be controlled and guided by pushing and pulling the shafts of the main and auxiliary scopes (such as through the use of pull wires extending into the shafts of the main and auxiliary scopes). The pull wires are typically anchored at the distal end of the shaft and connected to a controller at the proximal end of the shaft, allowing them to slide freely within the shaft between them. The action of a knob or lever on the controller can cause the pull wires to induce bending of the shaft. Typically, the pull wires are arranged in pairs to create bends on opposite sides of the shaft. [Prior art documents] [Patent Documents]

[0007] [Patent Document 1] PCT Publication No. WO2011 / 140118A1 [Overview of the Initiative] [Problems that the invention aims to solve]

[0008] This disclosure recognizes that problems to be solved by conventional medical devices (in particular endoscopes and duodenoscopy) include, among other things, the undesirable phenomenon of the slender insertion shaft of an endoscope shrinking due to various factors. For example, the shaft of an endoscope is typically made from polymer material. Such material can shrink due to various factors (including environmental conditions, transport conditions, and aging). In particular, the insertion shaft may be exposed to sterilization procedures performed at elevated temperatures. In an example, the shaft of an endoscope may shrink by about 3 to 4 millimeters. The resulting shrinkage of the insertion shaft may result in a knob dwell. A knob dwell is the presence of slack in the pull wire configured to bend the distal end of the slender insertion shaft. The slack results in a control feature for the pull wire (e.g., the knob) having a certain amount of unresponsiveness. For example, the knob can be rotated without the distal end of the slender insertion shaft bending while the slack in the pull wire is removed during operation. After the slack is removed, rotating the knob in the same direction will create the desired tension in the pull wire during operation. However, rotating the knob in the opposite direction requires the slack in the opposing pull wire to be removed before responsiveness can be achieved. This process is repeated each time the knob is rotated in the opposite direction. Therefore, knob dwell creates an undesirable user experience.

[0009] This disclosure can help provide solutions to these and other problems by providing systems, devices, and methods for reducing or eliminating slack in pull wires, in particular slack that occurs after manufacturing and / or sterilization due to shrinkage in the axial length of elongated insertion shafts. [Means for solving the problem]

[0010] In the example, the present disclosure includes a number of devices and associated methods for displacing an elongated insertion shaft relative to a control handle in order to remove slack from a pull wire within the elongated insertion shaft.

[0011] In additional examples, the disclosure includes a number of devices and associated methods for displacing a pull wire relative to an elongated insertion shaft in order to remove slack from the pull wire within the elongated insertion shaft.

[0012] In this example, the endoscope includes a handpiece housing, an elongated flexible shaft extending from the handpiece housing, a pull wire extending from the handpiece housing into the elongated flexible shaft, and a tensioning mechanism configured to adjust the tension in the pull wire.

[0013] In the example, a method for adjusting the tension in the pull wire of a controller for an endoscope includes the steps of preparing the endoscope for use before the procedure, adjusting the tension in the pull wire to deflect the flexible elongated shaft of the endoscope to reduce knob dwell, and performing the endoscopic procedure with the endoscope. [Brief explanation of the drawing]

[0014] [Figure 1] This diagram shows a schematic representation of an imaging and control system, as well as an endoscopic examination system including an endoscope (such as a duodenoscopy), in which the tensioning device of the present disclosure may be used together. [Figure 2] It is a schematic diagram of the imaging and control system of FIG. 1, showing the imaging and control system connected to the endoscope. [Figure 3] It is an exploded view of the handle section and the shaft of the endoscope, including a first example of the tensioning mechanism according to the present disclosure. [Figure 4A] It is a side view of the tensioning mechanism of FIG. 3, with the shaft in the retracted state. [Figure 4B] It is a side view of the tensioning mechanism of FIG. 3, with the shaft in the extended state. [Figure 5] It is a top view of the tensioning mechanism of FIGS. 3 to 4B, showing the geometry of the rotary tensioning mechanism. [Figure 6A] It is a side view of the tensioning mechanism including a spring and a removable pin. [Figure 6B] It is a side view of the tensioning mechanism including a spring and a removable pin. [Figure 7A] It is a side view of the spring-loaded tensioning mechanism in the retracted state. [Figure 7B] It is a side view of the spring-loaded tensioning mechanism in the advanced state. [Figure 8] It is a perspective view of the tensioning mechanism including a ratchet mechanism. [Figure 9] It is a perspective view of the tensioning mechanism including an internal screw mechanism with a lever. [Figure 10A] It is an external view of the tensioning mechanism including an internal screw mechanism with a knob. [Figure 10B] It is an internal view of the tensioning mechanism including an internal screw mechanism with a knob. [Figure 11] It is a schematic cross-sectional view of the tensioning mechanism including a button-activated wedge. [Figure 12A]Schematic cross-sectional view of a spring-loaded tensioning mechanism for a pull wire in a standby state. [Figure 12B] Schematic cross-sectional view of a spring-loaded tensioning mechanism for a pull wire in an activated state. [Figure 12C] Side cross-sectional view of a tensioner of a spring-loaded tensioning mechanism of FIGS. 12A and 12B showing a pull wire seated in a trough. [Figure 13A] Schematic cross-sectional view of a torsion spring tensioning mechanism for a pull wire in a standby state. [Figure 13B] Schematic cross-sectional view of a torsion spring tensioning mechanism for a pull wire in an activated state. [Figure 13C] Schematic top view of the torsion spring tensioning mechanism of FIGS. 13A and 13B. [Figure 14A] Schematic cross-sectional view of a rotatable tensioning mechanism for a pull wire in a standby state. [Figure 14B] Schematic cross-sectional view of a rotatable tensioning mechanism for a pull wire in an activated state. [Figure 15A] Perspective view of a rotatable barrel tensioning mechanism of the present disclosure including a knob component and a barrel component. [Figure 15B] Perspective view of a first side of the knob component of FIG. 15A. [Figure 15C] Perspective view of a second side of the knob component of FIG. 15A. [Figure 15D] Perspective view of a first side of the barrel component of FIG. 15A. [Figure 15E] Perspective view of a second side of the barrel component of FIG. 15A. [Figure 15F] Perspective view of the rotatable barrel tensioning mechanism of FIG. 15A in a standby state. [Figure 15G] Perspective view of the rotatable barrel tensioning mechanism of FIG. 15A in an intermediate state. [Figure 15H] Figure 15A is a perspective view of the rotatable barrel tensioning mechanism in its activated state. [Figure 16A] This is a schematic cross-sectional view of a rack and pinion tensioning mechanism for a pull wire in standby mode. [Figure 16B] This is a schematic cross-sectional view of a rack and pinion tensioning mechanism for a pull wire in the activated state. [Figure 17A] This figure shows a retention strap for an auxiliary scope, which is wrapped around the primary scope to activate the tensioning mechanism of the present disclosure. [Figure 17B] This figure shows a retention strap for an auxiliary scope, which is wrapped around the primary scope to activate the tensioning mechanism of the present disclosure. [Figure 17C] This figure shows a retention strap for an auxiliary scope, which is wrapped around the primary scope to activate the tensioning mechanism of the present disclosure. [Figure 18] These are schematic diagrams of the auxiliary scopes shown in Figures 17A and 17B, which are positioned inside the packaging container. [Figure 19] For example, this is a block diagram illustrating the operation of various methods for reducing slack in a pull wire in order to reduce knob dwell. [Figure 20] This is a flowchart showing a reprocessing method for the systems, therapeutic devices, and components disclosed in this application. [Modes for carrying out the invention]

[0015] Figure 1 is a schematic diagram of an endoscopic system 10 including an imaging and control system 12 and an endoscope 14. The system in Figure 1 is an example of an endoscopic system suitable for use with the systems, devices, and methods described herein (such as tensioning mechanisms for pull wires). However, the pull wire devices and methods of this disclosure can also be used in other configurations of endoscopic systems. According to some examples, the endoscope 14 may be insertable into an anatomical region for imaging and / or may provide passage for other devices (such as auxiliary scopes and biopsy devices, or one or more therapeutic devices for treating disease conditions associated with an anatomical region). In advantageous embodiments, the endoscope 14 may interface with and connect to the imaging and control system 12. In the illustrated examples, the endoscope 14 includes a duodenal endoscope, but other types of endoscopes can also be used with the features and teachings of this disclosure.

[0016] The imaging and control system 12 may include a control unit 16, an output unit 18, an input unit 20, a light source unit 22, a fluid source 24, and a suction pump 26.

[0017] The imaging and control system 12 may include various ports for connecting to the endoscopy system 10. For example, the control unit 16 may include data input / output ports for receiving data from and communicating data to the endoscope 14. The light source unit 22 may include an output port for transmitting light to the endoscope 14, such as via a fiber optic link. The fluid source 24 may include a port for transmitting fluid to the endoscope 14. The fluid source 24 may include a fluid pump and tank, or it may be connected to an external tank, container, or storage unit. The suction pump 26 may include a port used to draw a vacuum from the endoscope 14 to generate suction, such as to draw fluid from the anatomical region into which the endoscope 14 is inserted. The output unit 18 and input unit 20 are used by the user of the endoscopy system 10 (e.g., the operator) to control the functions of the endoscopy system 10 and to view the output of the endoscope 14. The control unit 16 may be additionally used to generate signals or other outputs by treating the anatomical region into which the endoscope 14 is inserted. In this example, the control unit 16 can generate electrical output, acoustic output, fluid output, etc., to treat an anatomical area, for example, by cauterization, cutting, or freezing.

[0018] The endoscope 14 may include an insertion section 28, a functional section 30, and a handle section 32, which can be connected to a cable section 34 and a coupler section 36. The coupler section 36 is connected to a control unit 16, and the endoscope 14 can be connected to several features of the control unit 16 (such as an input unit 20, an optical source unit 22, a fluid source 24, and a suction pump 26).

[0019] The insertion section 28 may extend distally from the handle section 32, and the cable section 34 may extend proximal to the handle section 32. The insertion section 28 may be elongated and may include a bending section and a distal end, and the functional section 30 may be attached to the distal end. The bending section may be controllable (e.g., by a control knob 38 on the handle section 32) to maneuver the distal end through a winding anatomical passage (e.g., stomach, duodenum, kidney, ureter, etc.). In this example, a pair of pull wires may be anchored in the functional section 30 and extend through the insertion section 28, and may also be connected to the control knob 38 to control the bending or deflection of the bending section. The insertion section 28 may also include one or more working channels (e.g., internal lumens), one or more working channels may be elongated and may support the insertion of one or more therapeutic tools (e.g., auxiliary scopes) into the functional section 30. The working channel may extend between the handle section 32 and the functional section 30. Additional functionality (such as fluid passages, guide wires, and pull wires) may also be provided by the insertion section 28 (for example, via suction or perfusion passages).

[0020] The handle section 32 may include a control knob 38 and a port 40A. As described, the control knob 38 may be connected to a pull wire (or other operating mechanism) extending through the insertion section 28. In the example, the handle section 32 may include a lever, wheel, or other control element for pushing and pulling the pull wire. Port 40A and other ports (such as port 40B (Figure 2)) may be configured to connect various electrical cables, guide wires, auxiliary scopes, tissue collection devices, fluid tubes, etc., to the handle section 32 for connection to the insertion section 28.

[0021] For example, the imaging and control system 12 can be provided on a mobile platform (e.g., a cart 41) equipped with shelves for housing the light source unit 22, suction pump 26, image processing unit 42 (Figure 2), etc. Alternatively, some components of the imaging and control system 12 shown in Figures 1 and 2 can be provided directly on the endoscope 14, making the endoscope "self-contained".

[0022] Functional section 30 may include components for treating and diagnosing the patient's anatomical structure. Functional section 30 may also include module 50, which may include imaging devices, lighting devices, and elevators.

[0023] Figure 2 is a schematic diagram of the endoscopic examination system 10 of Figure 1, including an imaging and control system 12 and an endoscope 14. Figure 2 schematically illustrates the components of the imaging and control system 12 connected to the endoscope 14, the endoscope 14 including a duodenoscope in the illustrated example. The imaging and control system 12 may include a control unit 16, which may include, or be connected to, an image processing unit 42, a treatment generator 44, and a drive unit 46, as well as a light source unit 22, an input unit 20, and an output unit 18. A coupler section 36 is connected to the control unit 16 as shown in Figure 1, and the endoscope 14 can be connected to several features of the control unit 16 (such as the image processing unit 42 and the treatment generator 44). In the example, port 40A can be used to insert another instrument or device (such as a daughterscope or auxiliary scope) into the endoscope 14. Such instruments and devices can be independently connected to the control unit 16 via a cable 47. In this example, port 40B can be used to connect coupler section 36 to various inputs and outputs (such as video, air, light, and electricity). The control unit 16 can be configured to activate a camera to view target tissue distal to the endoscope 14. Similarly, the control unit 16 can be configured to activate a light source unit 22 to illuminate the endoscope 14 or other devices extending from it.

[0024] The image processing unit 42 and the light source unit 22 can interface with the endoscope 14 (for example, in the functional section 30) by wired or wireless electrical connections, respectively. Thus, the imaging and control system 12 can illuminate an anatomical region, collect signals representing the anatomical region, process the signals representing the anatomical region, and display an image representing the anatomical region on the output unit 18. The imaging and control system 12 may include a light source unit 22 for illuminating the anatomical region using light of a desired spectrum (e.g., broadband white light, narrowband imaging using suitable electromagnetic wavelengths, etc.). The imaging and control system 12 can be connected to the endoscope 14 (for example, via an endoscope connector) for signal transmission (e.g., optical output from the light source, video signals from the imaging system at the distal end, diagnostic signals and sensor signals from diagnostic devices, etc.).

[0025] The fluid supply source 24 (Figure 1) can communicate with the control unit 16 and may include one or more sources of air, saline, or other fluids, as well as associated fluid pathways (e.g., air channels, perfusion channels, suction channels) and connectors (barb fittings, fluid seals, valves, etc.). The fluid supply source 24 may be used as starting energy for the biasing or pressure-applying devices of this disclosure. The imaging and control system 12 may also include a drive unit 46, which may be an optional component. The drive unit 46 may include at least a motor-driven drive for advancing the distal section of the endoscope 14, as described in PCT Publication WO2011 / 140118A1, titled "Rotate-to-Advance Catheterization System" by Frassica et al., which is incorporated herein by reference in its entirety.

[0026] Figure 3 is an exploded view of an endoscope controller 200 including a handle section 202, a shaft 204, and a tensioning mechanism 206, the tensioning mechanism 206 may include a first example of a tensioning mechanism according to this disclosure. The tensioning mechanism 206 may include a strain relief 208, a sheath collar 210, a cap 212, a shaft hub 214, a rotary mechanism 216, a stop 218, and standoffs 220A and 220B. Figure 4A is a side view of the tensioning mechanism 206 of Figure 3 with the shaft 204 in a retracted position. Figure 4B is a side view of the tensioning mechanism 206 of Figure 3 with the shaft 204 in an extended position. The strain relief 208 is displaced distally in Figure 4B to show the sheath collar 210 and the rotary mechanism 216. Figure 5 is a top view of the tensioning mechanism 206 shown in Figures 3 to 4B, and illustrates the geometric shape of the rotary mechanism 216. Figures 3 to 5 are discussed concurrently.

[0027] The handle section 202 may include a controller housing 203, with only half of the controller housing 203 shown in Figure 3. The controller housing 203 may be divided into two shell parts, the two shell parts being mirror images of each other. The two halves of the controller housing 203 may be joined together to enclose the tensioning mechanism 206. The controller housing 203 may include a socket 205 for receiving a pull wire actuator (such as a lever or knob).

[0028] The shaft 204 can be placed in a socket 222 within the handle section 202 and configured to slide freely within it. The shaft 204 can include a pull wire extending from its proximal end, which can be connected to a drum or barrel positioned in the socket 205. For example, the shaft 204 and controller housing 203 can be configured as the shaft 608 and handle housing 606 in Figures 12A and 12B, and the actuator (such as actuator 610) can be positioned in the socket 205. Thus, the handle section 202 can include a pull wire similar to the pull wires 602A and 602B shown in Figures 12A and 12B.

[0029] As discussed herein, the handle section 202 may be subjected to manufacturing and environmental conditions that could introduce slack into the pull wire, which could ultimately create a knob dwell in the actuator for the pull wire. Thus, the pull wire may contain slack. The tensioning mechanism 206 can be configured to eliminate or reduce slack from the pull wire.

[0030] The pull wire can be fixed at the distal end of the shaft 204. The pull wire can be sized to accommodate a specific distance between the socket 205 and the distal end of the shaft 204 (e.g., having a predetermined length) and accommodate any fixed obstacles by the controller housing 203. Thus, as the shaft 204 changes shape (e.g., as its length is reduced), the proximal end face 207 of the shaft 204 may move closer to the socket 205 than before the shaft 204 changed shape, resulting in the occurrence of slack. In the example, the shaft 204 can be contracted, thereby shortening its length, and the pull wire can be made longer than desired to create a change in the position of the distal end of the shaft 204 when the actuator is displaced, for example, longer than desired to create no or little knob dwell. In short, the pull wire can be made longer than necessary to extend between the socket 205 and the distal end of the shaft 204.

[0031] The stop 218 can be positioned around the shaft 204 on the opposite side of the tip 223 and can be fixed to the shaft 204. The sheath collar 210 can be positioned around the shaft 204 in front of the stop 218 and the tip 223. The rotary mechanism 216 can be positioned around the sheath collar 210 so that the pin 230 extends into the channel 232. The strain relief 208 can be positioned around the rotary mechanism 216. The strain relief 208 can be positioned around the shaft 204 to prevent twisting or sharp bending of the shaft 204 in the harder material of the tip 223 of the controller housing 203, thereby preventing the occurrence of strain in the material of the shaft 204. The sheath collar 210, the rotary mechanism 216, and the strain relief 208 can be configured to move relative to the controller housing 203 via a connection to the shaft 204. In other words, as the shaft 204 moves or slides within the socket 222, the components of the sheath collar 210, the rotary mechanism 216, and the strain relief 208 can move accordingly, either in translational or rotational motion, as described below.

[0032] The shaft 204 can be attached to the controller housing 203 via the shaft hub 214. The shaft hub 214 may include a slider 240 and lobes 242A and 242B. The proximal end of the shaft 204 can be attached to a channel 226 of the shaft hub 214 to prevent movement of the shaft 204. The cap 212 can be positioned on the shaft 204 on the opposite side of the shaft hub 214. The cap 212 and the shaft hub 214 can be attached to the shaft 204 by any suitable means (adhesive, coupling, fasteners, etc.). The shaft hub 214 can be positioned such that slots 228A and 228B are positioned adjacent to standoffs 220A and 220B, respectively. The standoffs 220A and 220B may include pedestals, and the shaft hub 214 can slide against the pedestals. Standoffs 220A and 220B may each include bores for receiving fasteners 244A and 244B, respectively, which can pass through slots 228A and 228B. The heads of fasteners 244A and 244B may hold lobes 242A and 242B against standoffs 220A and 220B, respectively. Bushings 246A and 246B may each be positioned around the shafts of fasteners 244A and 244B, respectively, and may be positioned within slots 228A and 228B, respectively. Bushings 246A and 246B may facilitate alignment between the shaft hub 214 and the socket 222, and smooth sliding or translation of the shaft hub 214.

[0033] As can be seen in Figure 5, the strain relief 208 may include a cylindrical body having an internal lumen, within which a rotary mechanism 216 can be installed. The outer surface of the rotary mechanism 216 may fit tightly into the lumen of the strain relief 208, so that the strain relief 208 and the rotary mechanism 216 move together (for example, rotate). The rotary mechanism 216 may include a cylindrical body having an internal lumen, within which a sheath collar 210 can be installed. The outer surface of the sheath collar 210 may fit loosely into the lumen of the rotary mechanism 216, so that the rotary mechanism 216 can rotate around the sheath collar 210. The sheath collar 210 may include a cylindrical body having an internal lumen, within which a shaft 204 can be installed. The outer surface of the shaft 204 is capable of fitting tightly into the lumen of the sheath collar 210, so that the shaft 204 and the sheath collar 210 move together (for example, translate). As discussed below, the interaction between the sheath collar 210 and the rotary mechanism 216 makes it possible to convert the rotational movement of the strain relief 208 into the axial movement of the shaft 204.

[0034] The rotation of the strain relief 208 allows the rotary mechanism 216 to rotate, which in turn allows the channel 232 of the rotary mechanism 216 to push the pin 230, thereby pushing the sheath collar 210. The axial position of the strain relief 208 relative to the controller housing 203 can be fixed by the use of a flange on the strain relief 208 or rotary mechanism 216 positioned within the channel in the controller housing 203, or via a similar mechanism. The shaft 204 can be constrained to not rotate by connecting it to the shaft hub 214, thereby preventing the sheath collar 210 from rotating as well. The curved, helical, or spiral shape of the channel 232 allows the rotational movement of the rotary mechanism 216 to be converted into axial movement of the sheath collar 210 via the sliding of the pin 230 within the channel 232. Since the sheath collar 210 can be attached to the shaft 204, moving the sheath collar 210 allows for the movement of the shaft 204. Moving the shaft 204 allows for adjustment of the tension or slack of the pull wire positioned within the shaft 204. The tensioning mechanism 206 may include a helical drive tensioning mechanism.

[0035] In the example, the strain relief 208 may be provided with markings, symbols, or instructions indicating in which direction or by how much to rotate the strain relief 208 to reduce or eliminate pull wire slack and knob dwell. In the illustrated example, the strain relief 208 may be configured to rotate downward relative to the orientation in Figure 3 to cause tightening of the pull wire. The downward rotation of the strain relief 208 may cause leftward movement of the shaft 204. Thereafter, the strain relief 208 may be provided with markings (such as written alphanumeric text 247 and icons (such as arrow 248)) indicating the correct direction for rotating the strain relief 208 to provide pull wire tensioning.

[0036] As shown in Figure 4A, the shaft hub 214 can be positioned proximal (or to the right in Figure 4A) after manufacturing. Thus, the shaft hub 214 can be positioned at a distance from the end wall 224, and the bushings 246A and 246B can be located at the proximal ends of slots 228A and 228B, respectively. Contraction of the shaft 204 allows the distal end of the shaft 204 to move proximal, thereby introducing slack into the pull wire. The strain relief 208 can be rotated in one direction (for example, clockwise when viewed proximal along the shaft 204 from the distal end) to position the shaft hub 214 distally, as shown in Figure 4B, thereby applying tension to the pull wire and removing slack from the pull wire. Therefore, the shaft hub 214 can engage with the end wall portion 224, and the bushings 246A and 246B can be positioned at the distal ends of slots 228A and 228B, respectively.

[0037] In the example, the rotation of the strain relief 208 can be binary action (e.g., on / off movement), so that the user of the endoscope controller 200 does not need to decide how much to rotate the strain relief 208. Thus, the strain relief 208 can provide a stop for the outermost position of rotation. In the example, the stop can simply include one or both of the end wall portion 224 or the ends of slots 228A and 228B. In the example, the stop can include a return stop (e.g., a spring-loaded ball) which can be made to seat in a groove to lock relative movement, which can allow the strain relief 208 to snap into the appropriate position at the rotating end. In the example, intermediate steps can exist between the rotating ends, allowing the user to select the amount of tension to apply to the pull wire. For example, the strain relief 208 can provide an intermediate return stop.

[0038] In the example, the controller housing 203 may include a window 249 for indicating the proximal end of the shaft 204 or shaft hub 214. In the example, the window 249 may provide a mark (such as a red / green gauge) for providing the user with an indication of the tension level of the pull wire in order to determine whether tightening is required or desired. For example, if the proximal end of the shaft hub 214 is positioned above the red indicator, it may indicate that additional tightening (e.g., rotation of the strain relief 208) is advantageous, or if the proximal end of the shaft hub 214 is positioned above the green indicator, it may indicate that the tightening of the pull wire and the position of the strain relief 208 are acceptable. Such a gauge (or another go / no-go gauge located on the controller housing 203, shaft hub 214, or somewhere else) can provide useful feedback to the user when the strain relief 208 is not configured in a "set it and forget it" or "on / off" configuration. Additionally, such a gauge may be useful for the user to select the desired amount of knob dwell.

[0039] Figures 6A and 6B are side views of a spring-loaded tensioning mechanism 300, including a spring 302 and a pin 304. The spring-loaded tensioning mechanism 300 can be incorporated into an endoscope controller 306, which includes a handle housing 308, and the shaft 310 is connected to the handle housing 308. The shaft 310 can provide strain relief 312. The handle housing 308 and shaft 310 can be configured as described with reference to Figures 3 to 5. The strain relief 312 is provided around the shaft 310 and can prevent strain from being induced into the shaft 310 from bending in the handle housing 308.

[0040] The pull wires 314A and 314B can extend from the shaft 310 to the actuator 316. The actuator 316 can include a wheel 318, a lever 320, and a knob 322. In the example, the pull wires 314A and 314B can include the opposite end portions of a single wire wound around the wheel 318. In the example, the pull wires 314A and 314B can include two different wires connected to the wheel 318.

[0041] The spring-loaded tensioning mechanism 300 can be disposed inside or on top of the handle housing 308 so as to interact with the pull wires 314A and 314B. The spring-loaded tensioning mechanism 300 can include a spring 302, a flange 324 on the shaft 310, and a pin 304. The handle housing 308 can include an opening 326 for receiving the pin 304 and a flange 328 for pressing against the spring 302.

[0042] As discussed herein, the endoscope controller 306 may be subjected to manufacturing and environmental conditions that could introduce slack into the pull wires 314A and 314B. Thus, the pull wires 314A and 314B may contain slack 330A and 330B. The spring-loaded tensioning mechanism 300 can be configured to eliminate or reduce slack 330A and 330B from the pull wires 314A and 314B, respectively.

[0043] The pull wires 314A and 314B can be fixed at the distal end of the shaft 310. The pull wires 314A and 314B can be sized to accommodate a specific distance between the actuator 316 and the distal end of the shaft 310 (for example, having a predetermined length) and accommodate any fixed obstructions by the handle housing 308. Thus, as the shaft 310 changes shape (for example, as its length is reduced), the flange 324 of the shaft 310 may move closer to the actuator 316 than before the shaft 310 changed shape, resulting in the occurrence of slack. In this example, the shaft 310 is retractable, thereby shortening its length, and the pull wires 314A and 314B are made longer than desired to create a change in the position of the distal end of the shaft 310 when the actuator 316 is operated, for example, longer than desired to create no or very little knob dwell. In short, the pull wires 314A and 314B can be longer than necessary to extend between the actuator 316 and the distal end of the shaft 310.

[0044] The spring-loaded tensioning mechanism 300 can be configured to push or pull the pull wires 314A and 314B in order to remove slack 330A and 330B from the pull wires 314A and 314B, and to increase the length the pull wires must travel to reach the distal end of the shaft 310 from the actuator 316. The spring-loaded tensioning mechanism 300 can be configured so that the spring 302 pushes the shaft 310 when the pin 304 is removed. In the example, the user can remove the pin 304 when removing the endoscope controller 306 from the packaging (such as a tray). In the example, the pin 304 can be connected to a tether 332, which can be secured to the packaging to facilitate removal.

[0045] As shown in Figure 6A, the endoscope controller 306 can be positioned in the packaging before use, with slacks 330A and 330B present in the pull wires 314A and 314B, respectively. The shaft 310 can be retracted proximal after manufacturing and sterilization. In the example, the pin 304 can be positioned between the flange 324 and the housing wall 334 when fully advanced into the opening 326. Thus, the spring 302 can be compressed between the flange 324 of the shaft 310 and the flange 328 of the handle housing 308. The tether 332 can contain slack, allowing the endoscope controller 306 to be removed from the packaging.

[0046] As shown in Figure 6B, the pin 304 can be retracted within the opening 326 or completely removed from the handle housing 308, allowing the shaft 310 to move distally. In particular, with the pin 304 retracted, the spring 302 becomes free and is able to press against the flange 324. The distance the shaft 310 can advance can be configured to compensate for the contraction of the shaft 310, as well as the occurrence of corresponding slack 330A and 330B. The spring 302 does not apply tension or compression to the shaft 310 until the user moves the pin 304. Such a configuration may be advantageous in that the spring 302 does not apply constant compression to the shaft 310, which could cause additional deformation of the shaft 310 under certain conditions. The tether 332 may be taut and broken when the user removes the endoscope controller 306 from its packaging. A retaining mechanism 336 may be included so that when the shaft 310 is pushed distally, the shaft 310 can be locked in the distal position, so that the force of the spring 302 does not need to hold the shaft 310 in place, and so that the shaft 310 cannot retract proximally without a force exceeding the force typically generated in the pull wires 314A and 314B. In the example, the retaining mechanism 336 may be configured to allow the flange 324 to move easily distally beyond the retaining mechanism 336, but not to allow it to move proximally backward beyond the retaining mechanism. In the example, the retaining mechanism 336 may include a spring-loaded ball or wedge mounted in the handle housing 308 which can roll or slide along the shaft 310 and then move into a groove in the shaft 310 to fix the axial movement of the shaft 310.

[0047] Figures 7A and 7B are side views of the spring-loaded tensioning mechanism 350 in the retracted and forward positions, respectively. The spring-loaded tensioning mechanism 350 may include a spring 352 for pressing against the shaft 354. The spring-loaded tensioning mechanism 350 may further include a shuttle 356, a guide body 358, and a backstop 360. The shuttle 356 may include a proximal section 362, a distal section 364, a proximal flange 366, a distal flange 368, and an intermediate flange 370. The spring-loaded tensioning mechanism 350 can be mounted in the handle housing 372 of the endoscope controller 374.

[0048] The endoscope controller 374, including the handle housing 372, can be configured similarly to the endoscope controller 200 and controller housing 203 in Figure 3, and the endoscope controller 306 and handle housing 308 in Figures 6A and 6B. The shaft 354 can be configured to slide within the neck portion 376. The pull wires 378A and 378B can be configured to extend from the shaft 354 to an operating mechanism (such as an operating mechanism similar to the actuator 316 in Figures 6A and 6B).

[0049] In the example, the spring 352 can be configured to continuously push the shaft 354 through the shuttle 356. The spring 352 can be extended when the shaft 354 is contracted. Thus, the spring 352 can be configured to continuously remove slack from the pull wires 378A and 378B. However, to avoid inducing any additional stress in the shaft 354, the spring 352 can be configured to operate selectively by the user. In an additional example, the spring 352 can be initially set in a compressed state and held in place via a pin (not shown) similar to the pin 304 in Figures 6A and 6B. The pin can be removed to push the shaft 354 distally to remove slack (e.g., before use).

[0050] The proximal end of the shaft 354 is connected to a shuttle 356 having a proximal flange 366 and a distal flange 368 that engage with a flange 379 of the guide body 358, thereby allowing control over the furthest range of movement of the shaft 354. A spring 352 can be pushed between the backstop 360 and the intermediate flange 370 to move the shaft 354. In this example, the proximal flange 366 and the distal flange 368 can be taller than the proximal portion 362 and the distal portion 364 of the shuttle 356 in order to engage with the flange 379 of the guide body 358, and the intermediate flange 370 of the shuttle 356 can be wider than the proximal portion 362 and the distal portion 364 of the shuttle 356 in order to engage with the spring 352. The intermediate flange 370 can be configured to fit between the flanges 379 of the shuttle 356. A return mechanism (not shown) may be included, which allows the shaft 354 to lock in the distal position when it is pushed distally, so that the force of the spring 352 does not need to hold the shaft 354 in place and prevents the shaft 354 from retracting proximal. In this example, the return mechanism may include a spring-loaded ball or wedge mounted in the handle housing 372, which is capable of rolling or sliding along the shaft 354 or shuttle 356, and then moving into a groove in the shaft 354 or shuttle 356, thereby fixing the axial movement of the shaft 354.

[0051] As shown in Figure 7A, the shaft 354 can be positioned such that the flange 379 of the guide body 358 is between the distal flange 368 and the intermediate flange 370 of the shuttle 356. A pin (not shown) can hold the shuttle 356 in place, allowing slack 380A and 380B to be present in the pull wires 378A and 378B, respectively. As discussed herein, slack 380A and 380B can be induced by contraction of the shaft 354 due to manufacturing and sterilization procedures or exposure to ambient heat.

[0052] As shown in Figure 7B, a pin (not shown) can be removed from engagement with the shuttle 356 and the guide body 358, allowing the shuttle 356 to move freely within the guide body 358 under the force of the spring 352. Thus, the spring 352 can press against the intermediate flange 370, causing the shuttle 356 to advance distally. In this example, the shuttle 356 can advance distally until the proximal flange 366 engages with the flange 379 of the guide body 358, or until the distal flange 368 engages with the end wall 382 of the handle housing 372. Thus, the slack 380A and 380B can be removed from the pull wires 378A and 378B, respectively, due to the pull wires 378A and 378B being attached to the distal end of the shaft 354.

[0053] Furthermore, the spring-loaded tensioning mechanism 350 may include a gauge for indicating the amount of tension being applied, or markings for providing instructions for operating the spring-loaded tensioning mechanism 350.

[0054] Figure 8 is a perspective view of the tensioning mechanism 400, which includes a ratchet mechanism incorporated into the handle section 401. The shaft 402 can be mounted on the ratchet 404. The housing 406 can include teeth 408. The teeth 408 can be engaged by pawls 410. The user can push the lever 412 forward or distally to move the shaft 402 forward. The teeth 408 and pawls 410 can be configured to allow forward movement and prevent backward movement. The rail 414 of the housing 406 engages with the slot 416 of the ratchet 404, maintaining the axial alignment of the shaft 402 within the housing 406.

[0055] The shaft 402 can be placed in a socket 418 within the housing 406 and configured to slide freely within it. The shaft 402 can include a pull wire extending from its proximal end, and the pull wire can be connected to a drum or barrel positioned in the proximal portion of the housing 406. For example, the shaft 402 and housing 406 can be configured as the shaft 608 and handle housing 606 in Figures 12A and 12B, and the actuator (such as actuator 610) can be positioned in a socket 205. Thus, the handle section 401 can include a pull wire similar to the pull wires 602A and 602B.

[0056] As discussed herein, the handle section 401 may be subjected to manufacturing and environmental conditions that could cause the shaft 402 to contract, which could introduce slack into the pull wire. The tensioning mechanism 400 can be configured to eliminate or reduce slack from the pull wire.

[0057] The pull wire can be fixed at the distal end of the shaft 402. The pull wire can be sized to accommodate a specific distance between the tensioner (not shown) and the distal end of the shaft 402 (e.g., having a predetermined length) and accommodate any fixed obstructions by the housing 406. Thus, as the shaft 402 changes shape (e.g., as its length decreases), the proximal end face 420 of the shaft 402 may move closer to the actuator compared to before the shaft 402 changed shape, resulting in the occurrence of slack. In the example, the shaft 402 can be retracted, thereby shortening its length, so that the pull wire is longer than desired to create a change in the position of the distal end of the shaft 402 when the actuator is operating, for example, longer than desired to create no or very little knob dwell. In short, the pull wire can be longer than required to extend between the actuator and the distal end of the shaft 402.

[0058] In this example, the handle section 401 can be removed from the packaging for use. The ratchet 404 can be retracted proximal to the rail 414. The ratchet 404 can be held in place on the rail 414 by the engagement of the teeth of the pawl 410 with the teeth 408 of the ratchet strip 409 of the housing 406. A spring can be incorporated to apply pressure to the lever pawl 410 and maintain the engagement of the teeth. The lever 412 can extend through an opening in the housing 406 to allow the user to interface with the ratchet 404. As the shaft 402 retracts, the distal end of the shaft 402 moves closer to the proximal end face 420, which may induce slack in the pull wire extending from the proximal end face.

[0059] Before using the handle section 401, the user can push the lever 412 distally or forward along the housing 406 to move the shaft 402 distally via the ratchet 404 and remove slack from the pull wire. The rail 414 can be inserted into the slot 416 to facilitate the sliding of the ratchet 404. The rail 414 and slot 416 can be elongated to facilitate axial alignment between the shaft 402 and the housing 406. Furthermore, multiple rails 414 and slot 416 on both sides of the ratchet 404 can prevent undesirable rotation of the ratchet 404. The teeth of the pawl 410 can be configured to engage with the teeth 408, allowing forward or distal movement but preventing backward or proximal movement. For example, the rear or proximal surface of the tooth 408 can be inclined distally to allow the pawl 410 to advance distally, while the front or distal surface of the tooth 408 can be made vertical (for example, perpendicular to the axis of the rail 414) to prevent the pawl 410 from retracting proximal. Additionally, the ratchet 404 can be provided with other features (such as a stopper) to prevent the shaft 402 from moving proximal. Furthermore, the tensioning mechanism 400 can include a gauge for indicating the amount of tension being applied, or markings for providing instructions for operating the tensioning mechanism 400.

[0060] Figure 9 is a perspective view of the tensioning mechanism 450, which includes an internal screw mechanism incorporated into the handle section 451. The tensioning mechanism 450 may include a lever 452, which may be configured to extend outside the housing 453 to allow a user to operate the tensioning mechanism 450.

[0061] In this example, the tensioning mechanism 450 can be configured similarly to the tensioning mechanism 206 in Figures 3-5, except that the rotatable component is located within the housing 453 and accessible via the lever 452, rather than being operated by the rotation of the strain relief 208 (Figure 3). The tensioning mechanism 450 may include a helical drive tensioning mechanism.

[0062] Lever 452 can extend through a slot in the housing 453 and connect to a hub 454 having a slot 456, the shape of which can be arc-shaped or spiral. Shaft 458 can include a collar 460 (shown by dashed lines in the hub 454) having a pin 462 configured to sit in the slot 456. Hub 454 can be supported in the housing 453 via a connection to shaft hub 464. Shaft hub 464 can include wings 466 which can be fixed to the housing 453 by fasteners (not shown) and projections 468 which can extend into the hub 454. Shaft hub 464 can additionally include a channel 470 which can allow a pull wire to access shaft 458. Hub 454 can be fixed axially between a shoulder portion above projection 468 and a wall portion 472 of the housing 453.

[0063] With this configuration, the user can rotate the hub 454 by using the lever 452. The rotational movement of the hub 454, induced by the lever 452, allows the slot 456 to apply force to the pin 462. The curvature of the slot 456 can induce the axial movement of the collar 460, as it prevents the hub 454 from moving axially and allows the collar 460 to rotate and move axially. The shaft 458 can be pushed forward by the collar 460, and rotation can be prevented by the engagement of the pin 462 and the slot 456. Figure 9 illustrates the pin 462 and one of the slots 456, but additional pins and slots can also be provided on the opposite side of the collar 460 and hub 454.

[0064] In the example, the tensioning mechanism 450 may include spring assistance to help push the shaft 458 forward or distally. In the example, the tensioning mechanism 450 may provide a stopper for holding the lever 452 in a forward and retracted position, as well as in an intermediate position to allow the user to set a desired amount of pull wire tension or knob dwell. Furthermore, the tensioning mechanism 450 may include a gauge for indicating the amount of tension applied, or markings for providing instructions for operating the tensioning mechanism 450.

[0065] Figures 10A and 10B are external and internal views of a screw-type tensioning mechanism 500, including an internal screw mechanism incorporated into the handle section 501. The screw-type tensioning mechanism 500 may include a knob 502 for moving the shaft 504. The knob 502 may be accessible from outside the housing 506. A knob 503 may be connected to a pull wire extending into the shaft 504. The knob 503 may be rotated to push and pull the distal end of the shaft 504 using the pull wire. The knob 502 may be rotated to provide tension in the pull wire and eliminate or reduce knob dwell.

[0066] In this example, the screw-type tensioning mechanism 500 can be configured similarly to the tensioning mechanism 450 in Figure 9, but the lever 452 is replaced with a knob 502.

[0067] In the example, the screw-type tensioning mechanism 500 may include screw-type engagements, such as lead screws or jack screws, for pushing and pulling the shaft 504 forward and backward. In such an example, the screw-type tensioning mechanism 500 may include a screw portion 508 and a guide portion 510. The guide portion 510 may include a slide body having a channel 512 configured to engage with a rib 514 extending from the housing 506, similar to that in Figure 8. The screw portion 508 may include a bore 516 for allowing pull wires 518A and 518B to pass through the screw-type tensioning mechanism 500 and enter the shaft 504. The guide portion 510 may additionally include slots 520 for allowing pull wires 518A and 518B to slide smoothly against and guide away from the screw-type tensioning mechanism 500.

[0068] The knob 502 can be rotated by an operator from outside the housing 506. In this example, the knob 502 can be configured to rotate in only one direction. For example, the knob 502 can be configured to apply tension to the pull wires 518A and 518B and not to induce slack. Furthermore, the knob 502 or the housing 506 can provide a mark to indicate the direction in which the knob should be rotated to tighten the pull wires 518A and 518B. The knob 502 can be prevented from moving axially within the housing 506 by positioning it within the window 522 of the housing 506. The housing 506 can include a pair of windows, with one window on each side of the housing 506. Since the knob 502 is prevented from moving axially, rotation of the knob 502 can drive axial movement of the screw portion 508 through a screw engagement. The knob 502 can be rotated to multiple positions between the most proximal and most distal positions of the screw-type tensioning mechanism 500, allowing the user to control the amount of tension in the pull wires 518A and 518B.

[0069] In the example, the screw-type tensioning mechanism 500 may include a locking mechanism (such as a return stopper) to hold the shaft in a forward or distal position after the knob 502 has been activated. In the example, the return stopper may include a spring-loaded ball or wedge mounted in the housing 506, which may roll or slide along the shaft 504 or guide portion 510, and then move into a groove in the shaft 504 or guide portion 510 to fix the axial movement of the shaft 504.

[0070] Figure 11 is a schematic cross-sectional view of a tensioning mechanism 550, which includes a button-activated wedge incorporated into a handle section 551. The tensioning mechanism 550 may include a button 552 and a wedge 554. The wedge 554 may be positioned at the proximal end of the shaft 556 or at another location thereon. The button 552 may extend through the housing 558 and be in contact with the wedge 554. The button 552 and the wedge 554 may have complementary angled surfaces, such that axial movement of the button 552 into the housing 558 may cause axial movement of the wedge 554 out of the housing 558. In this example, the button 552 may move perpendicular to the wedge 554. In the example, the tensioning mechanism 550 may include a locking mechanism (such as a stopper) to hold the shaft 556 in a forward or distal position after the button 552 has been activated, or to hold the button 552 or wedge 554 in a radially inward position. In an additional example, a toggle linkage may be provided to lock the button 552, wedge 554, or shaft 556 in the correct position. The angle between the button 552 and the wedge 554 may be controlled (e.g., set) to determine (e.g., control) the amount of force applied to the button 552 to displace the shaft 556.

[0071] The housing 558 may include any housing described herein (such as the controller housing 203 in Figure 3). The housing 558 may include a four-way pull wire system including a first pulley 560A, a second pulley 560B, a first knob 562A, and a second knob 562B. The first pulley 560A can be connected to a pull wire pair 564A, and the second pulley 560B can be connected to a pull wire pair 564B. The tensioning mechanism 550 may be configured such that a wedge 554 simultaneously applies tension to all the pull wires of the pull wire pair 564A and the pull wire pair 564B.

[0072] Examples in Figures 3 to 11 and Figures 16A and 16B show that slack in one or more pull wires can be reduced or eliminated by applying translational movement (e.g., axial movement) to the endoscope shaft and indirectly removing the slack through the movement of the shaft. Various tensioning mechanisms can be configured to apply tension to a single pull wire, a pair of pull wires, or a pair of pull wires. Examples in Figures 12A to 15H show that a direct force can be applied to move one or more pull wires (e.g., to displace them radially). In various examples of this disclosure, the tensioning mechanisms in Figures 3 to 11 and Figures 16A and 16B can be applied to a first pair of pull wires, and the tensioning mechanisms in Figures 12A to 15H can be applied to a second pair of pull wires, allowing for different tensioning of the pull wire pair. In the example, the different tensioning mechanisms shown in Figures 3 to 15H can be individually applied to one, two, three, four, or more pull wires in various combinations to achieve individual pull wire tensioning.

[0073] Figure 12A is a schematic cross-sectional view of the spring-loaded tensioning mechanism 600 with respect to pull wires 602A and 602B in a standby state. Figure 12B is a schematic cross-sectional view of the spring-loaded tensioning mechanism 600 of Figure 12A in an activated state. Figures 12A and 12B are discussed together.

[0074] The spring-loaded tensioning mechanism 600 can be used within the endoscope controller 604. The endoscope controller 604 can include a handle housing 606 and a shaft 608. The handle housing 606 can be configured similarly to the handle section 202 in Figure 3, and the shaft 608 can be configured similarly to the shaft 204 in Figure 3. The shaft 608 and the handle housing 606 can be connected to each other in a fixed manner, or they can be connected to each other in a sliding manner, as described with reference to Figures 3 to 5.

[0075] The pull wires 602A and 602B can extend from the shaft 608 and can be connected to the actuator 610. The actuator 610 can include a wheel 612, a lever 614, and a knob 616. In the example, the pull wires 602A and 602B can include opposing end portions of a single wire wound around the wheel 612. In the example, the pull wires 602A and 602B can include two different wires connected to the wheel 612.

[0076] The spring-loaded tensioning mechanism 600 can be disposed inside or on top of the handle housing 606 to interact with the pull wires 602A and 602B. The spring-loaded tensioning mechanism 600 may include a first tensioner 615A, a second tensioner 615B, an actuation mechanism 617, a button 618, a spring 620, a first stop 624A, and a second stop 624B.

[0077] As discussed herein, the endoscope controller 604 may be subjected to manufacturing and environmental conditions that could introduce slack into the pull wires 602A and 602B. Thus, the pull wires 602A and 602B may contain slack 622A and 622B. The spring-loaded tensioning mechanism 600 can be configured to eliminate or reduce slack 622A and 622B from the pull wires 602A and 602B, respectively.

[0078] The pull wires 602A and 602B can be fixed at the distal end of the shaft 608. The pull wires 602A and 602B can be sized to accommodate a specific distance between the actuator 610 and the distal end of the shaft 608 (for example, having a predetermined length) and the handle housing 606 accommodates any fixed obstacles. Thus, as the shaft 608 changes shape (as its length decreases), the proximal end face 623 of the shaft 608 may come closer to the actuator 610 than before the shaft 608 changed shape, resulting in the occurrence of slack. In the example, the shaft 608 can be retracted, thereby shortening its length, so that the pull wires 602A and 602B are longer than those required to adjust the distal end of the shaft 608, resulting in the occurrence of slack 622A and 622B. As shown in Figure 12A, the pull wires 602A and 602B can be longer than desired to create a change in the position of the distal end of the shaft 608 when the actuator 610 is operating, for example, they can be longer than desired to create no knob dwell at all or very little. In short, the pull wires 602A and 602B can be longer than required to extend between the actuator 610 and the distal end of the shaft 608.

[0079] The spring-loaded tensioning mechanism 600 can be configured to push or pull the pull wires 602A and 602B in order to increase the length the pull wires must travel from the actuator 610 to reach the distal end of the shaft 608 in order to remove slack 622A and 622B from the pull wires 602A and 602B. The spring-loaded tensioning mechanism 600 can be configured so that the first tensioner 615A and the second tensioner 615B are released from the pull wires 602A and 602B so as not to affect the tension of the pull wires 602A and 602B, as shown in Figure 12A. However, the first tensioner 615A and the second tensioner 615B can be moved to engage with the pull wires 602A and 602B, respectively, in order to remove slack 622A and 622B, as shown in Figure 12B. Tensioners 615A and 615B can increase the respective path lengths of the pull wires 602A and 602B by creating an indirect path between the shaft 608 and the actuator 610 to remove slack 622A and 622B. In the example in Figures 12A and 12B, tensioners 615A and 615B are illustrated to push the pull wires 602A and 602B outward, but they can be configured to pull or push the pull wires 602A and 602B inward or outward.

[0080] The first tensioner 615A and the second tensioner 615B may include deflectors or other body parts that can be moved to engage with the pull wires 602A and 602B. In the example, the tensioners 615A and 615B may be configured as stationary pulleys or rotatable pulleys. The first tensioner 615A and the second tensioner 615B may each include arcuate surfaces 625A and 625B, respectively, and the pull wires 602A and 602B may slide against the arcuate surfaces 625A and 625B. Thus, the first tensioner 615A and the second tensioner 615B may avoid inducing stress or twisting in the pull wires 602A and 602B. In the example, as shown in Figure 12C, the arc-shaped surface 625A may include flanges 626A and 626B and a trough 628 for maintaining the pull wire 602A in alignment and engagement with the first tensioner 615A. The second tensioner 615B may be configured similarly to the first tensioner 615A.

[0081] Button 618 can be actuated to release tension in spring 620 in order to cause movement of the first tensioner 615A and the second tensioner 615B. Button 618 can be connected to an actuation mechanism 617, which may include a tether or linkage connected to the first tensioner 615A and the second tensioner 615B. By pressing button 618, the actuation mechanism 617 can be released from the first tensioner 615A and the second tensioner 615B. In an additional example, buttons may be provided individually for each of the tensioners 615A and 615B.

[0082] In the illustrated example, the first tensioner 615A and the second tensioner 615B are configured to move outward from a location between the pull wires 602A and 602B in order to push the pull wires 602A and 602B outward. However, the actuation mechanism 617 can be configured to pull the pull wires 602A and 602B from an external location. In an additional example, the tether or linkage of the actuation mechanism 617 can remain attached to the first tensioner 615A and the second tensioner 615B, and the actuation of the button 618 can be configured to cause the movement of the first tensioner 615A and the second tensioner 615B directly from the tether or linkage. Thus, in the example, the spring 620 can be omitted, and a catch mechanism (e.g., one or more retainers) can be included to maintain the tether or linkage of the actuation mechanism in the forward or actuation position.

[0083] In the illustrated example, the first tensioner 615A and the second tensioner 615B are configured to act simultaneously on the pull wires 602A and 602B, respectively. However, in additional examples, each of the first tensioner 615A and the second tensioner 615B may be provided with a dedicated operating mechanism and button to allow individual control over the tensioning of the pull wires 602A and 602B.

[0084] Figure 13A is a schematic cross-sectional view of the torsion spring tensioning mechanism 650 with respect to pull wires 652A and 652B in a standby state. Figure 13B is a schematic cross-sectional view of the torsion spring tensioning mechanism 650 of Figure 13A in an activated state. Figure 13C is a schematic top view of the torsion spring tensioning mechanism 650 of Figures 13A and 13B. Figures 13A to 13C are discussed together.

[0085] The torsion spring tensioning mechanism 650 can be used within the endoscope controller 654. The endoscope controller 654 can include a handle housing 656 and a shaft 658. The handle housing 706 can be configured similarly to the handle section 202 in Figure 3, and the shaft 658 can be configured similarly to the shaft 204 in Figure 3. The shaft 658 and the handle housing 656 can be connected to each other in a fixed manner, or they can be connected to each other in a sliding manner, as described with reference to Figures 3 to 5.

[0086] The pull wires 652A and 652B can extend from the shaft 658 and can be connected to the actuator 660. The actuator 660 can include a wheel 662, a lever 664, and a knob 666. In the example, the pull wires 652A and 652B can include opposing end portions of a single wire wound around the wheel 662. In the example, the pull wires 652A and 652B can include two different wires connected to the wheel 662.

[0087] The torsion spring tensioning mechanism 650 can be disposed inside or on top of the handle housing 656 to interact with the pull wires 652A and 652B. The torsion spring tensioning mechanism 650 can include a drum 670, a torsion spring 672, a spindle 674, and an actuation mechanism 676. The spindle 674 can be configured to sit on slots 678A (Figure 13C) and 678B. A first stop 680A and a second stop 680B can be mounted in the handle housing 656 to engage with the actuation mechanism 676. The actuation mechanism 676 can be connected to the spindle 674 to rotate the drum 670 between the first stop 680A and the second stop 680B.

[0088] As discussed herein, the endoscope controller 654 may be subjected to manufacturing and environmental conditions that could introduce slack into the pull wires 652A and 652B. Thus, the pull wires 652A and 652B may contain slack 684A and 684B. The torsion spring tensioning mechanism 650 can be configured to eliminate or reduce slack 684A and 684B from the pull wires 652A and 652B, respectively.

[0089] The pull wires 652A and 652B can be fixed at the distal end of the shaft 658. The pull wires 652A and 652B can be sized to accommodate a specific distance between the actuator 660 and the distal end of the shaft 658 (e.g., having a predetermined length) and accommodate any fixed obstacles by the handle housing 656. Thus, as the shaft 658 changes shape (e.g., as its length is reduced), the proximal end face 688 of the shaft 658 may move closer to the actuator 660 than before the shaft 658 changed shape, resulting in the occurrence of slack. In the example, the shaft 658 can be retracted, thereby shortening its length, so that the pull wires 652A and 652B are longer than desired to create a change in the position of the distal end of the shaft 658 when the actuator 660 is operating, for example, longer than desired to create no or very little knob dwell. In short, the pull wires 652A and 652B can be longer than those required to extend between the actuator 660 and the distal end of the shaft 658.

[0090] The torsion spring tensioning mechanism 650 can be configured to wind the pull wire 652B around the drum 670 in order to remove slack 684B from the pull wire 652B. In the standby state, the pull wire 652B can engage with the drum 670, as shown in Figure 13A, so that the pull wire 652A extends over or through the drum 670 along a first path. In the activated state, the drum 670 can rotate, as shown in Figure 13B, so that the pull wire 652B engages with the drum 670, and the pull wire 652A extends over or through the drum 670 along a second path (longer than the first path). Thus, the pull wire 652B can be tightened within the drum 670.

[0091] The drum 670 can be mounted on the spindle 674, which can be supported by slots 678A and 678B, formed within the handle housing 656, or contain a separate structure within the handle housing 656. Slots 678A and 678B can be mounted in the handle housing 656 in any suitable manner. An actuation mechanism 676 can be connected to the drum 670 to facilitate the rotation of the drum 670 on the spindle 674. The actuation mechanism 676 can include a lever extending through the handle housing 656 to enable user operation. In this example, the handle housing 656 can provide a first stop 680A and a second stop 680B, respectively, to facilitate holding or fixing the actuation mechanism 676 in the positions shown in Figures 13A and 13B. For example, the first stop 680A and the second stop 680B can include spring-loaded stoppers. The torsion spring 672 can connect the drum 670 to the spindle 674 so that the actuation mechanism 676 can rotate independently of the drum 670. That is, the actuation mechanism 676 can rotate the spindle 674, causing the drum 670 to rotate through interaction with the torsion spring 672. However, as the slack 684B is removed from the pull wire 652B, the torsion spring 672 can be wound up, allowing the spindle 674 and actuation mechanism 676 to rotate further so as to apply tension to the pull wire 652B and so as to allow the actuation mechanism 676 to engage with the second stop 680B.

[0092] In the example, the drum 670 may include a cylindrical body. In the example, the drum 670 may include a plate or a paddle.

[0093] In the example, spindle 674 can be connected to slots 678A and 678B using a ratchet mechanism that allows spindle 674 to rotate in one direction.

[0094] As discussed herein, the pull wire 652B can be mounted on the drum 670 to allow winding of the pull wire 652B of varying lengths around the drum 670 to remove slack 684B. Thus, the pull wire 652B is fixed in place on the drum 670. Thus, the drum 670 can be configured to be positioned within the handle housing 656 in a movable manner to enable the operation of the actuator 660. For example, when the actuator 660 rotates the wheel 662 clockwise in Figures 13A and 13B, the pull wire 652B moves to the left, and when the actuator 660 rotates the wheel 662 counterclockwise in Figures 13A and 13B, the pull wire 652B moves to the right. Therefore, to prevent the torsion spring tensioning mechanism 650 from anchoring the pull wire 652B on the handle housing 656 and from inducing slack in the pull wire 652B between the torsion spring tensioning mechanism 650 and the actuator 660 for clockwise rotation, and from inducing tension for counterclockwise rotation, the drum 670 is allowed to move left and right within the handle housing 656 on slots 678A and 678B. Thus, when the actuator 660 rotates the wheel 662 clockwise in Figures 13A and 13B, the spindle 674 moves to the left on slots 678A and 678B toward the distal end 690A, and when the actuator 660 rotates the wheel 662 counterclockwise in Figures 13A and 13B, the spindle 674 moves to the right on slots 678A and 678B toward the proximal end 690B.

[0095] Figures 13A and 13B illustrate a configuration having a torsion spring tensioning mechanism 650 configured to engage with a pull wire 652B. In additional examples, the torsion spring tensioning mechanism 650 can be provided on top of the pull wire 652A. In examples, the torsion spring tensioning mechanism 650 can be provided on top of the pull wire 652B, and a similarly configured tensioning mechanism can be provided on top of the pull wire 652A. In configurations using two rotatable tensioning mechanisms, the actuation mechanisms (e.g., actuation mechanism 676) can be linked together so that a single action can be used to activate both actuation mechanisms simultaneously.

[0096] Figure 14A is a schematic cross-sectional view of the rotatable tensioning mechanism 700 with respect to a pull wire in a standby state. Figure 14B is a schematic cross-sectional view of the rotatable tensioning mechanism 700 of Figure 14A in an activated state. Figures 14A and 14B are discussed together.

[0097] The rotatable tensioning mechanism 700 can be used within the endoscope controller 704. The endoscope controller 704 can include a handle housing 706 and a shaft 708. The handle housing 706 can be configured similarly to the handle section 202 in Figure 3, and the shaft 708 can be configured similarly to the shaft 204 in Figure 3. The shaft 708 and the handle housing 706 can be connected to each other in a fixed manner, or they can be connected to each other in a sliding manner, as described with reference to Figures 3 to 5.

[0098] The pull wires 702A and 702B can extend from the shaft 708 and can be connected to the actuator 710. The actuator 710 can include a wheel 712, a lever 714, and a knob 716. In the example, the pull wires 702A and 702B can include opposing end portions of a single wire wound around the wheel 712. In the example, the pull wires 602A and 602B can include two different wires connected to the wheel 712.

[0099] The rotatable tensioning mechanism 700 can be disposed inside or on top of the handle housing 706 to interact with the pull wires 702A and 702B. The rotatable tensioning mechanism 700 may include a drum 717, a tensioner 718, an actuation mechanism 719, a shaft 720, a first bearing 723A, and a second bearing 723B.

[0100] As discussed herein, the endoscope controller 704 may be subjected to manufacturing and environmental conditions that could introduce slack into the pull wires 702A and 702B. Thus, the pull wires 702A and 702B may contain slack 722A and 722B. The rotatable tensioning mechanism 700 can be configured to eliminate or reduce slack 722A and 722B from the pull wires 702A and 702B, respectively.

[0101] The pull wires 702A and 702B can be fixed at the distal end of the shaft 708. The pull wires 702A and 702B can be sized to accommodate a specific distance between the actuator 710 and the distal end of the shaft 708 (for example, having a predetermined length) and accommodate any fixed obstacles by the handle housing 706. Thus, as the shaft 708 changes shape (for example, as its length is reduced), the proximal end face 724 of the shaft 708 may move closer to the actuator 710 than before the shaft 708 changed shape, resulting in the occurrence of slack. In this example, the shaft 708 can be retracted, thereby shortening its length, so that the pull wires 702A and 702B are longer than desired to create a change in the position of the distal end of the shaft 708 when the actuator is displaced, for example, longer than desired to create no or very little knob dwell. In short, the pull wires 702A and 702B can be longer than necessary to extend between the actuator 710 and the distal end of the shaft 708.

[0102] The rotatable tensioning mechanism 700 can be configured to push or pull the pull wire 702B in order to remove slack 722B from the pull wire 702B, thereby increasing the distance the pull wire must travel to reach the distal end of the shaft 708 from the actuator 710. The rotatable tensioning mechanism 700 can be configured to rotate the drum 717 so that the tensioner 718 is released from the pull wire 702B without affecting the tension of the pull wire 702B, as shown in Figure 14A. However, the drum 717 can be rotated to move the tensioner 718 to engage with the pull wire 702B in order to remove slack 722B, as shown in Figure 14B.

[0103] The drum 717 can be mounted on the shaft 720, which can be supported by a first bearing 723A and a second bearing 723B. In this example, the shaft 720 can extend parallel (or nearly parallel) to the axis of the pull wire 702B. The first bearing 723A and the second bearing 723B can be mounted on the handle housing 706 in any suitable manner. The first bearing 723A and the second bearing 723B can facilitate the rotation of the shaft 720. An actuation mechanism 719 can be connected to the drum 717 to facilitate the rotation of the drum 717 on the shaft 720. The actuation mechanism 719 can include a lever extending through the handle housing 706 to allow operation by a user. In this example, the handle housing 706 may provide latches 726A and 726B to facilitate holding or fixing the actuation mechanism 719 in the positions shown in Figures 14A and 14B, respectively. For example, latches 726A and 726B may include spring-loaded return mechanisms. In this example, a spring (such as a coil spring) may be connected to the drum 717 to facilitate the forward movement of the drum 717 to the actuation position shown in Figure 14B when the actuation mechanism 719 is freed from latch 726A.

[0104] In the example, the drum 717 may include a cylindrical body. In the example, the drum 717 may include a plate or a paddle.

[0105] In this example, the first bearing 723A and the second bearing 723B may include, or may be equipped with, a ratchet mechanism that allows the shaft 720 to rotate in one direction.

[0106] The tensioner 718 may include a post or peg that can push the pull wire 702B. The tensioner 718 may have a rounded or curved shape to prevent twisting or coupling of the pull wire 702B. In the example, the tensioner 718 may include a hole or through bore within the post or peg. The pull wire 702B may extend through the hole or through bore to ensure that the pull wire 702B does not slip off the tensioner 718 or otherwise detach from the tensioner 718. In the example, the tensioner 718 may include a hoop or wicket attached to the drum 717, through which the pull wire 702B may extend. In the example, the handle housing 706 may include additional guides (such as bumpers or rails) for guiding the pull wire 702B from the shaft 708 around the drum 717 to the actuator 710.

[0107] Figures 14A and 14B illustrate a configuration having a rotatable tensioning mechanism 700 configured to engage with the pull wire 702B. In an additional example, the rotatable tensioning mechanism 700 may be provided on top of the pull wire 702A. In the example, the rotatable tensioning mechanism 700 may be provided on top of the pull wire 702B, and a similarly configured tensioning mechanism may be provided on top of the pull wire 702A. In a configuration using two rotatable tensioning mechanisms, the actuation mechanisms (e.g., actuation mechanism 719) may be linked together so that a single action can be used to activate both actuation mechanisms simultaneously. In an additional example, the drum 717 may be sized so that opposing sides of the drum 717 are positioned close to the pull wires 702A and 702B, and the opposing sides of the drum 717 may provide a tensioner (e.g., tensioner 718) to engage with the pull wires 702A and 702B. Therefore, a single drum and a single actuation movement can be used to simultaneously apply tension to both pull wires 702A and 702B.

[0108] Figure 15A is a perspective view of the rotatable barrel tensioning mechanism 750 of this disclosure, including a knob component 752 and a barrel component 754. The rotatable barrel tensioning mechanism 750 can be incorporated into an actuator for operating the pull wire of an endoscope controller. For example, the rotatable barrel tensioning mechanism 750 can be incorporated into the actuator 610 in Figure 12A, the actuator 660 in Figure 13A, the actuator 710 in Figure 14A, or the actuator 810 in Figure 16A, and other actuators suitable for use with the systems in Figures 3 to 11. The rotatable barrel tensioning mechanism 750 can be used as a replacement for the spring-loaded tensioning mechanism 600 in Figure 12A, the torsion spring tensioning mechanism 650 in Figure 13A, the rotatable tensioning mechanism 700 in Figure 14A, and the rack and pinion tensioning mechanism 800 in Figure 16A. However, in various examples, the rotatable barrel tensioning mechanism 750 can be used in conjunction with the spring-loaded tensioning mechanism 600 in Figure 12A, the torsion spring tensioning mechanism 650 in Figure 13A, the rotatable tensioning mechanism 700 in Figure 14A, and the rack and pinion tensioning mechanism 800 in Figure 16A, or with other mechanisms in Figures 3 to 11.

[0109] Figure 15B is a first side perspective view of the knob component 752 of Figure 15A. Figure 15C is a second side perspective view of the knob component 752 of Figure 15A. The knob component 752 may include a knob disc 756, a knob shaft 758, and a clutch disc 760. The knob disc 756 may include a knob 762. As shown in Figure 15C, the clutch disc 760 may include a stop slot 766, and the knob component 752 may further include a clutch 768 and a spring 770. The clutch 768 may include a pivot 772 and an extension 774.

[0110] Figure 15D is a first side perspective view of the barrel component 754 of Figure 15A. Figure 15E is a second side perspective view of the barrel component 754 of Figure 15A. The barrel component 754 may include a barrel end wall 776, a barrel side wall 778, a post 780, and a base 782. The barrel side wall 778 may include a clutch socket 784 and a stop 790, and the clutch socket 784 may include a central portion 786 and an extension portion 788.

[0111] During operation, the pull wire can be attached to or extend through the barrel end wall portion 776 of the barrel component 754. For example, as shown in Figure 15A, the barrel end wall portion 776 can include a first opening 792 and a first groove portion 794. The end of the pull wire can be inserted into the first opening 792 and secured therein by knots, fasteners, welding, etc. In this example, the pull wire can be wrapped around the knob shaft 758 and secured thereto, or it can be made into a loop around the knob shaft 758. The first groove portion 794 can extend from the first opening 792 and provide a path for the pull wire that gradually joins to the outside of the barrel end wall portion 776 to prevent twisting, etc. A second opening and groove portion can be provided on the barrel end wall portion 776 on the opposite side of the first opening 792 and the first groove portion 794. Therefore, a pair of pull wires can be attached to the barrel end wall 776 and anchored thereon. During operation, as will be described in more detail below, the barrel component 754 can be rotated by the knob component 752 to guide pushing and pulling the pull wires connected to the barrel end wall 776. In this example, the barrel component 754 may include the first pulley 560A or the second pulley 560B in Figure 11, or any of the wheels described herein (such as wheel 318 in Figure 6A, wheel 612 in Figure 12A).

[0112] The rotatable barrel tensioning mechanism 750 can be configured to operate by a knob component 752 and a barrel component 754 to remove slack in the pull wire before the pushing and pulling of the pull wire occurs, as discussed with reference to Figures 15F to 15H.

[0113] The clutch disc 760 can be positioned inside the barrel end wall 776, and the clutch 768 faces the barrel side wall 778. The clutch 768 can contact the barrel side wall 778 outside the clutch socket 784. In this example, the clutch 768 can contact the stop 790 on the opposite side of the clutch socket 784. With this configuration, the knob component 752 can initially rotate in only one direction relative to the barrel component 754.

[0114] The post 780 can be mounted on the housing of the endoscope control handle (e.g., handle housing 606 in Figure 12A, handle housing 656 in Figure 13A, handle housing 706 in Figure 14A, and handle housing 806 in Figure 16A). In the example, the post 780 can extend through a bore or opening within the housing, and the base 782 can be positioned outside the housing. In the example, the post 780 and the knob shaft 758 can extend coaxially. Thus, the barrel component 754 may be rotatable relative to the housing. Thus, the base 782 can act as another control knob. In other examples, the base 782 can be rotatably mounted within the housing.

[0115] Figure 15F is a perspective view of the rotatable barrel tensioning mechanism 750 of Figure 15A in a standby state. The configuration of Figure 15F can be the configuration of the rotatable barrel tensioning mechanism 750 when it is removed from packaging before use. Thus, the pull wire attached to the barrel end wall portion 776 can have slack through the mechanism described herein. The pull wire 796 can initially have slack 798. In the example, the pull wire 796 can be fed into a first groove portion 794 to be fixed to the knob shaft 758.

[0116] The knob 762 is gripped by the user and allows the knob disc 756 to rotate. As shown in Figure 15F, the knob disc 756 is rotatable clockwise, and the extension 774 is released from the stop 790 and slides along the barrel sidewall 778 in a clockwise arc. As arranged in Figure 15F, the knob component 752 is rotatable by almost a full turn before the extension 774 is positioned adjacent to the clutch socket 784 on the opposite side of the stop 790.

[0117] Figure 15G is a perspective view of the rotatable barrel tensioning mechanism 750 of Figure 15A in an intermediate state after rotation through an arc. As shown in Figure 15G, it is possible to remove the slack 798 from the pull wire 796. From the position in Figure 15G, the knob component 752 is able to rotate further so that the extension 774 is positioned on the extension portion 788 of the clutch socket 784. When positioned as shown in Figure 15G, the spring 770 is able to push the barrel component 754 upward relative to Figure 15G. Thus, the barrel component 754 is able to move toward the knob disc 756 away from the base 782. Such upward movement of the barrel component 754 is possible to cause the clutch socket 784 to be positioned on the extension 774, for example, so that the extension 774 moves into the clutch socket 784. Thus, the barrel component 754 is able to become rotatably engaged with the knob component 752.

[0118] Figure 15H is a perspective view of the rotatable barrel tensioning mechanism 750 of Figure 15A in the activated state. The knob component 752 is capable of continuing to rotate clockwise. The engagement of the extension 774 with the clutch socket 784 causes the barrel component 754 to rotate together with the knob component 752. In such a state, the rotation of the knob component 752 can induce pushing and pulling the pull wire connected to the barrel end wall portion 776, with the slack 798 removed from the pull wire 796.

[0119] Figure 16A is a schematic cross-sectional view of the rack and pinion tensioning mechanism 800 with respect to pull wires 802A and 802B in a standby state. Figure 16B is a schematic cross-sectional view of the rack and pinion tensioning mechanism 800 of Figure 16A in an activated state. Figures 14A and 14B are discussed together.

[0120] The rack and pinion tensioning mechanism 800 can be used within the endoscope controller 804. The endoscope controller 804 can include a handle housing 806 and a shaft 808. The handle housing 806 can be configured similarly to the handle section 202 in Figure 3, and the shaft 808 can be configured similarly to the shaft 204 in Figure 3. The shaft 808 and the handle housing 806 can be connected to each other in a fixed manner, or they can be connected to each other in a sliding manner, as described with reference to Figures 3 to 5.

[0121] The pull wires 802A and 802B can extend from the shaft 808 and can be connected to the actuator 810. The actuator 810 can include a wheel 812, a lever 814, and a knob 816. In the example, the pull wires 802A and 802B can include opposing end portions of a single wire wound around the wheel 812. In the example, the pull wires 802A and 802B can include two different wires connected to the wheel 812.

[0122] The rack and pinion tensioning mechanism 800 can be disposed inside or on top of the handle housing 806 to interact with the pull wires 802A and 802B. The rack and pinion tensioning mechanism 800 may include a rack 824, a pinion 826, a shaft 828, a spring 830, and an actuator 832.

[0123] As discussed herein, the endoscope controller 804 may be subjected to manufacturing and environmental conditions that could introduce slack into the pull wires 802A and 802B. Thus, the pull wires 802A and 802B may contain slack 822A and 822B. The rack and pinion tensioning mechanism 800 can be configured to eliminate or reduce slack 822A and 822B from the pull wires 802A and 802B, respectively.

[0124] The pull wires 802A and 802B can be fixed at the distal end of the shaft 808. The pull wires 802A and 802B can be sized to accommodate a specific distance between the actuator 810 and the distal end of the shaft 808 (for example, having a predetermined length) and accommodate any fixed obstacles by the handle housing 806. Thus, as the shaft 808 changes shape (for example, as its length is reduced), the proximal end face 834 of the shaft 808 may move closer to the actuator 810 than before the shaft 808 changed shape, resulting in the occurrence of slack. In the example, the shaft 808 can be retracted, thereby shortening its length, so that the pull wires 802A and 802B are longer than desired to create a change in the position of the distal end of the shaft 808 when the actuator is displaced, for example, longer than desired to create no or little knob dwell. In short, the pull wires 802A and 802B can be longer than necessary to extend between the actuator 810 and the distal end of the shaft 808.

[0125] The rack and pinion tensioning mechanism 800 can be configured to push or pull the pull wires 802A and 802B in order to increase the length the pull wires must travel from the actuator 810 to reach the distal end of the shaft 808 in order to remove slack 822A and 822B from the pull wires 802B. The rack and pinion tensioning mechanism 800 can be configured such that the rack 824 is in a first position so as not to affect the tension of the pull wires 802A and 802B, as shown in Figure 16A. However, the rack 824 can move forward (for example, linearly translate) away from the actuator 810 so that slack 822A and 822B is removed from the pull wires 802A and 802B, as shown in Figure 16B.

[0126] The rack 824 may include an elongated body having a first end connected to the proximal end face 834 of the shaft 808 and a second end extending therefrom. In this example, the rack 824 may be cantilevered from the shaft 808. The rack 824 may be rigidly connected to the shaft 808 and may include a rigid body configured to prevent movement of the rack 824 relative to the shaft 808. The outward-facing surface of the rack 824 may include gear teeth for engaging with the pinion 826. The pinion 826 may include a circular gear having gear teeth configured to mesh with the gear teeth of the rack 824. The pinion 826 may be mounted on the shaft 828 by any suitable means (such as a pinning connection). The pinion 826 may be fixed to the shaft 828 to prevent relative rotation between them. Spring 830 can be connected to shaft 828 and configured to bias shaft 828 to advance rack 824 to a distal position. In an example, shaft 828 may include a coil spring or torsion spring configured to induce rotation in shaft 828. Spring 830 can be connected to actuator 832. In the standby state of Figure 16A, actuator 832 can position shaft 808 to fix (for example, to prevent rotation of shaft 808) and hold rack 824 in a proximal position. In the activated state of Figure 16B, actuator 832 can be repositioned to be released from shaft 808, thereby allowing spring 830 to induce rotation in shaft 808. Actuator 832 may include a pin configured to engage with shaft 828, which can be pulled out by the movement of a lever extending through handle housing 806.The rotation of shaft 808 from spring 830 can cause rotation of pinion 826, which in turn causes the gear teeth of pinion 826 to push against the gear teeth of rack 824, causing translation of rack 824 away from handle housing 806. Shaft 808 can thereby be driven by rack 824 away from handle housing 806. The movement of shaft 808 away from handle housing 806 increases the distance between shaft 808 and actuator 810, thereby eliminating slack 822A and 822B in pull wires 802A and 802B.

[0127] Figures 17A, 17B, and 17C show a retention strap 900 for an auxiliary scope 902 that is wrapped around a primary scope 904 to activate the tensioning mechanism of the present disclosure. The primary scope 904 may include a shaft portion 906 that can extend between a proximal control handle and a distal working shaft. The auxiliary scope 902 may include a handle 908 to which the retention strap 900 may be attached. The handle 908 may include an actuator 910 that can be used to activate a pull wire tensioning mechanism as described herein, a lever 912 for operating features of the auxiliary scope 902, and an actuator 914 that can be used to activate a pull wire tensioning mechanism as described herein. In the example, the actuator 914 may include the button 618 in Figures 12A and 12B, the operating mechanism 719 in Figures 14A and 14B, the actuator 832 in Figures 16A and 16B, and features for other tensioning mechanisms described herein.

[0128] To facilitate simultaneous or synchronous operation of the auxiliary scope 902 and the primary scope 904, the auxiliary scope 902 can be mounted on the primary scope 904 in close proximity to the proximal control handle of the primary scope 904, facilitating the movement of both hands with one hand over each of the primary scope 904 and the auxiliary scope 902, or facilitating the preparation of one hand for movement between the primary scope 904 and the auxiliary scope 902. A retention strap 900 can be used to secure the auxiliary scope 902 to the primary scope 904. The handle 908 of the auxiliary scope 902 can include a groove 916, and the shaft portion 906 of the primary scope 904 can be positioned within the groove 916. Positioning the shaft portion 906 within the groove 916 can cause full or partial activation of the actuator 914. For example, actuator 914 can be displaced (e.g., pushed down) by the presence of shaft portion 906 in groove 916. Displacement of actuator 914 can cause the release of a tensioning mechanism as described herein. With shaft portion 906 in groove 916, retention strap 900 can be installed across shaft portion 906 and secured to handle 908 via appropriate means (such as hook-and-loop fasteners, snaps or buttons or fasteners). In this example, securing the free end of retention strap 900 to handle 908 can cause full displacement of actuator 914 and trigger the activation of a tensioning mechanism as described herein. Thus, the user of auxiliary scope 902 does not need to actively or intentionally remove slack from the pull wire, as the slack can be automatically removed by actuator 914 when auxiliary scope 902 is attached to primary scope 904.

[0129] Figure 18 is a schematic diagram of the auxiliary scope 902 of Figures 17A-17B positioned inside the packaging container 930. The packaging container 930 may include a tether 932 and an anchor 934. The tether 932 may include a first end attached to the actuator 914 and a second end attached to the anchor 934. The anchor 934 may be attached to the packaging container 930 in a fixed manner. The tether 932 may include a flexible cord or wire extending between the actuator 914 and the anchor 934. In this example, the tether 932 may be long enough to include slack when the handle 908 is positioned inside the packaging container 930. Thus, the handle 908 can be withdrawn a predetermined distance from the packaging container 930 before the tether 932 becomes taut. When the handle 908 is pulled away from the packaging container 930, the tether 932 can become taut before the actuator 914 is activated. Pulling the handle 908 away from the packaging container 930 by a distance longer than the length of the tether 932 with sufficient force can activate the actuator 914. In the example, the tether 932 can be attached in a detachable manner. In the example, the tether 932 can be attached to the actuator 914 in a detachable manner such that the force required to detach the tether 932 from the actuator 914 may be greater than the force required to activate the actuator 914. Thus, the handle 908 moving away from the packaging container 930 enough to cause separation between the actuator 914 and the tether 932 will first cause the actuator 914 to activate, followed by the detachment of the tether 932 from the anchor 934.

[0130] Figure 19 is a block diagram illustrating the operation of method 950 for reducing slack in a pull wire, for example, to reduce knob dwell.

[0131] In operation 952, the endoscope can be removed from the product packaging in preparation for use when performing a procedure. The endoscope can be removed from the wrapping paper or box, and then from the tray that holds the endoscope within the wrapping paper or box. Preparation for performing a procedure may additionally include attaching the endoscope to an additional endoscope (such as a primary scope or duodenoscope).

[0132] In operation 954A, the pull-wire tensioning mechanism can be automatically deployed. Automatic deployment of the tensioning mechanism can occur by removing the endoscope from its packaging, for example, by applying tension to the tether to activate the tensioning mechanism. In this example, tension can be applied to the tether to remove the pin. Automatic deployment can also occur by securing the endoscope to an additional endoscope with a strap, thereby activating the tensioning mechanism through the process of attaching the endoscope to an additional scope, thus avoiding the need for the user to perform a separate step specific to the tensioning mechanism.

[0133] In operation 954B, the pull wire tensioning mechanism can be actuated directly or manually. Direct or manual deployment can be performed by the user through direct intervention (such as pressing a button, rotating a knob, lever, or strain relief, or moving or removing a pin). Direct or manual operation can include moving the activation mechanism from the off position to the on position, or moving the activation mechanism to one or more intermediate positions between the off position and the on position.

[0134] In operation 956A, the pull wire tensioning mechanism can be activated by displacing the endoscope shaft. As discussed herein, the endoscope shaft can be displacing by the examples shown in Figures 3–11, 16A, and 16B, as well as by equivalent and other types of tensioning mechanisms.

[0135] In operation 956B, the pull wire tensioning mechanism can be activated by displacing the pull wire.

[0136] In operation 956B, the pull wire tensioning mechanism can be activated by displacing the pull wire. As discussed herein, the pull wire can be displacing by the examples in Figures 12A to 15H, as well as by equivalent and other types of tensioning mechanisms.

[0137] In operation 958, displacement of the endoscope shaft or pull wire can be corrected by removing slack in the pull wire, such as by applying tension to the pull wire. Slack resulting from manufacturing processes, sterilization processes, and environmental conditions, as discussed herein, can be reduced or eliminated by the tensioning mechanisms described herein.

[0138] In operation 960, the knob dwell in the actuator for pulling the pull wire can be reduced or eliminated by tensioning the pull wire in either operation 956A or 956B. Removing or reducing the slack in operation 958 makes it possible to remove or reduce the knob dwell in the actuator for operating the pull wire. Thus, removing or reducing the knob dwell makes it possible to provide use with more responsive operation of the endoscope.

[0139] In operation 962, a tension indicator can be viewed on the endoscope. The tension indicator can be used to provide the user with an indication of whether the tensioning mechanism should be activated or additionally actuated. For example, the tension indicator can provide an initial indication of slack in the pull wire by providing a window through which the pull wire can be viewed. In this example, the pull wire tensioning mechanism can be positioned close to a gauge or indicator that shows how far the tensioning mechanism should be moved, displaced, or actuated to provide a minimum, maximum, or intermediate level of tension in the pull wire. Thus, the user can select a desired amount of tension to reduce slack in order to provide or eliminate a desired amount of knob dwell.

[0140] In operation 964, the pull wire tensioning mechanism can be locked to prevent the pull wire from becoming slack again. For example, a stopper, latch, strap, or stop can be used to hold the tensioning mechanism in the forward, activated, or activated state to hold the pull wire at a desired level of tension. Such tensioning mechanism locks can be deployed automatically without user action or can be deployed manually by the user.

[0141] In operation 966, the endoscope can be operated using a pull-wire actuator. Once the pull-wire tensioning mechanism is moved to the desired setting and locked in place, the user can operate the endoscope and perform a medical procedure with a selected amount of knob dwell.

[0142] As discussed herein, this disclosure is useful in providing a mechanism for applying tension to a pull wire in an endoscope controller, housing, handpiece, etc. Such a pull wire can be used to provide articulation (e.g., bending) to the distal portion of the endoscope shaft. However, the pull wire may become slack as a result of various manufacturing and sterilization procedures, as well as exposure to environmental conditions. Applying tension to the pull wire can remove slack and the knob dwell resulting from the slack. Additionally, a tensioning mechanism can be used to allow a user to apply a desired amount of tension in the pull wire to produce a desired amount of responsiveness. A gauge or mark can be used to assist the user in determining whether the slack has been removed. The pull wire tensioning mechanism can be automatically deployed during the process of preparing the endoscope for use (e.g., removing it from packaging, rotating the pull wire operating mechanism in the normal course of action, or attaching the endoscope to another instrument (e.g., a primary scope)). The pull wire tensioning mechanism can be deployed manually or directly by removing a pin, pressing a button, or rotating a knob and lever.

[0143] Figure 20 is a flowchart of a reprocessing method 980 for therapeutic instruments disclosed in this application. The therapeutic instruments described above (such as the controller 200 in Figure 3, the controller 306 in Figure 6A, the controller 374 in Figure 7A, the handle section 401 in Figure 8, the handle section 451 in Figure 9, the handle section 501 in Figure 10A, the handle section 551 in Figure 11, the controller 604 in Figure 12A, the controller 654 in Figure 13A, the controller 704 in Figure 14A, the rotatable barrel tensioning mechanism 750 in Figure 15A, and the controller 804 in Figure 16A), as well as the insertion sections and working shafts that can be attached thereto, may be discarded after a single use or may be reused multiple times. In the case of configurations for reuse multiple times, for example, the reprocessing method shown in Figure 20 may be required or may be used. After the therapeutic instruments have been used for treatment, the operator collects the used therapeutic instruments and transports them to a factory or other location (step S1). Next, the operator cleans and sterilizes the collected and transported used therapeutic instruments (step S2). Then, the operator performs an acceptance check of the used therapeutic instruments (step S3). After that, the operator disassembles the used therapeutic instruments (step S4) and replaces some of the used parts of the therapeutic instruments with new parts (step S5). After step S5, the operator assembles the new or reprocessed therapeutic instruments (step S6). In some examples, step S6 may include adding an identifier to indicate that the device has been modified from its original state (e.g., adding a label or other marking to designate the device as reprocessed, repaired, or remanufactured). After step S6, the operator sequentially inspects (step S7), sterilizes and stores (step S8), and ships (step S9) the new therapeutic instruments. The therapeutic instruments according to this embodiment have a tensioning mechanism that can be reprocessed for multiple uses.Therefore, the tensioning mechanism of this disclosure has the advantage of being able to reduce the cost of medical procedures.

[0144] (Examples) Example 1 is an endoscope that includes a handpiece housing, an elongated flexible shaft extending from the handpiece housing, a pull wire extending from the handpiece housing into the elongated flexible shaft, and a tensioning mechanism configured to adjust the tension in the pull wire.

[0145] In Example 2, the subject of Example 1 optionally includes the fact that the tensioning mechanism is configured to adjust the position of an elongated flexible shaft relative to the handpiece housing in order to indirectly adjust the tension in the pull wire.

[0146] In Example 3, the subject of Example 2 optionally includes the inclusion of a rotatable hub positioned around an elongated flexible shaft, configured to guide the axial translation of the elongated flexible shaft.

[0147] In Example 4, the subject of Example 3 optionally includes the fact that the rotatable hub is positioned outside the handpiece housing and connected to a rotatable strain relief positioned around an elongated flexible shaft.

[0148] In Example 5, one or more of the themes from Examples 3 to 4 optionally include the fact that a rotatable hub is positioned inside the handpiece housing and connected to a lever extending through the handpiece housing.

[0149] In Example 6, one or more of the themes from Examples 3 to 5 optionally include that the rotatable hub includes a spiral slot and the elongated flexible shaft includes a pin configured to rest on the spiral slot.

[0150] In Example 7, one or more of the themes from Examples 2 to 6 optionally include the fact that an elongated flexible shaft is connected to a guide component for maintaining the elongated flexible shaft aligned within the handpiece housing.

[0151] In Example 8, one or more of the themes from Examples 2 to 7 optionally include the fact that the tensioning mechanism includes a spring-activated device.

[0152] In Example 9, the subject of Example 8 optionally includes that the spring-activated device includes a shuttle connected to an elongated flexible shaft, a guide body of a handpiece housing configured in which the shuttle slides, and a spring connected to the guide body for pressing the shuttle.

[0153] Example 10 optionally includes that one or more of the themes from Examples 8 to 9 include a spring-activated device comprising a stop wall portion of a handpiece housing, a proximal surface of an elongated flexible shaft, a spring disposed between the proximal surface and the stop wall portion, and a pin configured to hold the spring in a compressed state, the pin being displaceable relative to the handpiece housing to allow the spring to extend.

[0154] In Example 11, one or more of the themes from Examples 2 to 10 optionally include the fact that the tensioning mechanism includes a ratchet mechanism.

[0155] In Example 12, the subject of Example 11 is optionally further comprising a ratchet mechanism comprising a ratchet block connected to a rail extending from the handpiece housing and an elongated flexible shaft, wherein the ratchet block includes a slot for receiving the rail and a lever extending from the ratchet block to a location outside the handpiece housing, the lever including a lever tooth, and a ratchet strip having ratchet teeth configured to engage with the lever tooth.

[0156] In Example 13, one or more of the themes from Examples 2 to 12 optionally include the fact that the tensioning mechanism includes a screw mechanism.

[0157] In Example 14, the subject of Example 13 optionally includes that the screw mechanism includes a rail extending from the handpiece housing, a slide body including a slot for engaging with the rail, a screw body extending from the slide body and connected to an elongated flexible shaft, and a knob positioned around the screw body so as to extend at least partially through a window in the handpiece housing.

[0158] In Example 15, one or more themes from Examples 2 to 14 optionally include that the tensioning mechanism includes a button extending into the handpiece housing and a wedge connected to an elongated flexible shaft, the button being configured to engage with the wedge to displace the elongated flexible shaft in the axial direction.

[0159] Example 16 optionally includes the fact that one or more of the themes from Examples 2 to 15 include a rack and pinion tensioning mechanism configured to displace an elongated flexible shaft.

[0160] In Example 17, the subject of Example 16 optionally includes that the rack and pinion tensioning mechanism includes a rack gear connected to an elongated flexible shaft, a pinion gear mounted on the shaft to engage with the rack gear, a torsion spring configured to bias the shaft, and an actuator configured to selectively release compression of the torsion spring to rotate the pinion gear in order to drive the rack gear.

[0161] In Example 18, one or more themes from Examples 2 to 17 optionally include a locking mechanism for maintaining an elongated flexible shaft in a distal position after the tensioning mechanism is engaged.

[0162] In Example 19, one or more of the themes from Examples 1 to 18 optionally include a release mechanism configured to activate a tensioning mechanism when the endoscope is removed from the packaging component.

[0163] In Example 20, the subject of Example 19 optionally includes the fact that the release mechanism includes a tether attached to the tensioning mechanism in order to activate the tensioning mechanism.

[0164] In Example 21, one or more subjects from Examples 1 to 20 optionally include an actuation mechanism connected to the pull wire to pull the pull wire independently of the tensioning mechanism.

[0165] Example 22 optionally includes the fact that one or more themes from Examples 1 to 21 are configured to displace the pull wire in order to directly adjust the tension in the pull wire by increasing the distance the pull wire travels.

[0166] In Example 23, one or more of the themes from Examples 1 to 22 optionally include the fact that the tensioning mechanism includes an indicator.

[0167] In Example 24, the subject of Example 23 optionally includes the fact that the tensioning mechanism includes a spring-loaded tensioning mechanism configured to displace a pull wire.

[0168] In Example 25, the subject of Example 24 optionally includes that the spring-loaded tensioning mechanism includes a tensioner configured to engage with a pull wire, a spring configured to press against the tensioner, an operating mechanism configured to hold the spring in a compressed state, and a button accessible from outside the handpiece housing to release the operating mechanism.

[0169] Example 26 optionally includes the fact that one or more of the themes from Examples 23 to 25 include a torsion spring tensioning mechanism configured to wind up a pull wire.

[0170] In Example 27, the subject of Example 26 optionally includes a torsion spring tensioning mechanism comprising a drum mounted in the handpiece housing on a pin forming a rotation axis, a slot configured to receive the pin so as to allow the drum to move axially relative to the handpiece housing, and a torsion spring connecting the drum to the pin, wherein a pull wire is configured to wrap around the drum at least partially.

[0171] Example 28 optionally includes the fact that one or more of the themes from Examples 23 to 27 include a rotatable drum tensioning mechanism configured to displace a pull wire.

[0172] In Example 29, the subject of Example 28 optionally includes a rotatable drum tensioning mechanism comprising a drum mounted in a handpiece housing so as to rotate about an axis extending parallel to the pull wire, a tensioner extending from the drum to engage with the pull wire, and a lever connected to the drum to rotate the drum along the axis to displace the pull wire, wherein the tensioner is configured to displace the pull wire radially.

[0173] In Example 30, one or more of the themes from Examples 23 to 29 optionally include the fact that the tensioning mechanism includes a slack-removing barrel incorporated into the actuation mechanism for the pull wire.

[0174] In Example 31, the subject of Example 30 optionally includes a slack-removing barrel comprising a barrel rotatable on a first axis perpendicular to the pull wire, a knob rotatable on a second axis coaxial with the first axis, and a clutch mechanism configured to allow the knob to rotate relative to the barrel over an arc before the knob locks against the barrel, and the pull wire being configured to wrap around the barrel at least partially.

[0175] Example 32 is a method for adjusting tension in a pull wire of a controller for an endoscope, comprising the steps of preparing the endoscope for use before the procedure, adjusting the tension in the pull wire to deflect the flexible elongated shaft of the endoscope in order to reduce knob dwell, and performing an endoscopic procedure with the endoscope.

[0176] In Example 33, the subject of Example 32 optionally includes the step of preparing to use the endoscope before the procedure, which includes the step of removing the endoscope from its packaging.

[0177] In Example 34, the subject of Example 33 optionally includes the step of adjusting the tension in the pull wire to deflect the flexible elongated shaft of the endoscope in order to reduce knob dwell, which includes the step of activating a tensioning mechanism for adjusting the tension in the pull wire by removing the endoscope from the packaging.

[0178] In Example 35, the subject of Example 34 optionally includes the step of activating the tensioning mechanism by including the step of pulling a pin out of the tensioning mechanism with a tether.

[0179] In Example 36, one or more themes from Examples 32 to 35 optionally include a step of adjusting the tension in the pull wire to deflect the flexible elongated shaft of the endoscope in order to reduce knob dwell, which includes a step of displacing the flexible elongated shaft.

[0180] In Example 37, the subject of Example 36 optionally includes the step of displacing a flexible, elongated shaft, which includes the step of rotating a helical tensioning mechanism.

[0181] In Example 38, one or more of the themes from Examples 36 to 37 optionally include a step of displacing a flexible elongated shaft that includes a step of releasing a spring-activated tensioning mechanism.

[0182] In Example 39, one or more themes from Examples 36 to 38 optionally include a step of displacing a flexible elongated shaft that includes a step of rotating a screw-driven tensioning mechanism.

[0183] In Example 40, one or more themes from Examples 36 to 39 optionally include a step of displacing a flexible elongated shaft that includes a step of operating a rack and pinion tensioning mechanism.

[0184] In Example 41, one or more subjects from Examples 32 to 40 optionally include the step of viewing a tensioning mechanism gauge indicating the tension level.

[0185] In Example 42, one or more themes from Examples 32 to 41 optionally include the step of setting a tensioning mechanism lock to maintain tension in the pull wire.

[0186] In Example 43, one or more subjects from Examples 32 to 42 optionally include the step of operating the endoscope with a reduced level of knob dwell compared to before the endoscope is prepared for use prior to the procedure.

[0187] In Example 44, one or more themes from Examples 32 to 43 optionally include a step of displacing the pull wire in order to deflect the flexible elongated shaft of the endoscope in order to reduce knob dwell.

[0188] In Example 45, one or more themes from Examples 32 to 44 optionally include a step of displacing the pull wire, which includes a step of engaging a spring-loaded tensioner with the pull wire in order to displace the pull wire radially with respect to the axial direction of the pull wire.

[0189] In Example 46, one or more themes from Examples 32 to 45 optionally include a step of displacing the pull wire that includes a step of rotating the pull wire around a drum to increase the path of the pull wire.

[0190] In Example 47, one or more themes from Examples 32 to 46 optionally include a step of displacing the pull wire that includes a step of winding the pull wire into a drum to tighten the pull wire.

[0191] In Example 48, one or more themes from Examples 32 to 47 optionally include a step of displacing the pull wire, which includes a step of winding the slack of the pull wire into an actuator for pulling the pull wire in order to deflect the flexible elongated shaft of the endoscope.

[0192] In Example 49, one or more of the themes from Examples 32 to 48 optionally include the step of preparing to use the endoscope by including the step of attaching the endoscope to an additional endoscope.

[0193] In Example 50, the subject of Example 49 optionally includes the step of adjusting the tension in the pull wire to deflect the flexible elongated shaft of the endoscope in order to reduce knob dwell, by activating an actuator for a tensioning mechanism to adjust the tension in the pull wire by securing the endoscope to an additional endoscope with a strap.

[0194] Each of these non-limiting embodiments can stand alone or be combined with one or more of the other embodiments in various permutations or combinations.

[0195] Note The above detailed description includes references to the accompanying drawings, which form part of the detailed description. The drawings illustrate specific embodiments in which the present invention may be put into practice. 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 intend examples in which only those elements shown or described are provided. Furthermore, the inventors also intend examples using any combination or permutation of those elements shown or described (or one or more embodiments thereof) with respect to a particular example (or one or more embodiments thereof) or with respect to other examples (or one or more embodiments thereof) shown or described herein.

[0196] In the event of any inconsistency in usage between this document and any document incorporated by reference, the usage in this document shall prevail.

[0197] In this document, the terms "a" or "an" are used to include one or more, independently of any other instances or uses of "at least one" or "one or more," as is common in patent literature. In this document, the term "or" is used to refer to non-exclusive "or," so that "A or B" includes "A but not B," "B but not A," and "A and B," unless otherwise indicated. In this document, the terms "including" and "in which" are used as plain English equivalents of the terms "comprising" and "wherein," respectively. Furthermore, in the following claims, the terms "including" and "comprising" are open-ended, meaning that a system, device, article, composition, formulation, or process containing elements in addition to those listed after such terms in the claims is still considered to fall within the scope of those claims. Furthermore, in the following claims, terms such as “first,” “second,” and “third” are used merely as labels and are not intended to impose numerical requirements on those objects.

[0198] The above description is intended to be illustrative and not restrictive. For example, the above examples (or one or more of their embodiments) can be used in combination with each other. Other embodiments can be used by those skilled in the art who have considered the above description. The abstract is provided in accordance with 37 CFR §1.72(b) to enable the reader to quickly confirm the nature of the technical disclosure. It is submitted with the understanding that it is not to be used to interpret or limit the scope or meaning of the claims. Also, in the above detailed description, various features may be grouped together in order to streamline the disclosure. This should not be interpreted as meaning that any disclosed feature not claimed is essential to any claim. Rather, the subject matter of the invention may lie in fewer features than all the features of a particular disclosed embodiment. Accordingly, the following claims are incorporated into the detailed description as examples or embodiments, and it is intended that each claim stands alone as a separate embodiment, and such embodiments can be combined with each other in various combinations or permutations. The scope of the present invention should be determined by reference to the appended claims, along with the entire scope of equivalents to which such claims are protected. [Explanation of symbols]

[0199] 10 Endoscopy System 12 Imaging and control systems 14 Endoscopy 16 Control Unit 18 Output Units 20 Input Units 22 Light Source Unit 24 Fluid supply source 26 Suction pump 28 Insertion Section 30 Functional Sections 32 Handle section 34 Cable Sections 36. Coupler Section 38 Control knob 40A Port 40B Port 41 Cart 42 Image Processing Units 44 Therapy Generator 46 Drive Unit 47 Cables 50 modules 200 Endoscope Controllers 202 Handle Section 203 Controller Housing 204 Shaft 205 socket 206 Tensioning Mechanism 207 Proximal end face 208 Strain Relief 210 Sheath Color 212 Cap 214 Shaft Hub 216 Rotary Mechanism 218 Stop 220A Standoff 220B Standoff 222 sockets 223 Tip 224 End wall section 226 channels 228A slot 228B slot 230 pins 232 channels 240 Slider 242A Lobe 242B Lobe 244A Fasteners 244B Fasteners 246A Bushing 246B Bushing 247 alphanumeric text 248 Arrows 249 windows 300 Spring-loaded tensioning mechanism 302 Spring 304 pins 306 Endoscope Controller 308 Handle Housing 310 Shaft 312 Strain Relief 314A pull wire 314B Pull Wire 316 Actuator 318 wheels 320 Lever 322 Knob 324 Flange 326 Opening 328 Flange 330A Sagging 330B sagging 332 Tether 334 Housing wall section 336 Retraction Mechanism 350 Spring-loaded tensioning mechanism 352 Spring 354 shaft 356 Shuttle 358 Guide body 360 Backstop 362 Proximal portion 364 Distal portion 366 Proximal flange 368 Distal flange 370 Intermediate flange 372 Handle Housing 374 Endoscope Controller 376 Neck section 378A Pull Wire 378B Pull Wire 379 Flange 380A Sagging 380B sagging 382 End wall section 400 Tensioning Mechanism 401 Handle Section 402 Shaft 404 Ratchet 406 Housing 408 teeth 409 Ratchet Strip 410 claws 412 Lever 414 rails 416 slots 418 sockets 420 Proximal end face 450 Tensioning Mechanism 451 Handle Section 452 Lever 453 Housing 454 Hub 456 slots 458 shaft 460 Colors 462 pins 464 Shaft Hub 466 Wing 468 Protrusion 470 channels 472 Wall 500 Screw-type tensioning mechanism 501 Handle Section 502 Knob 503 Knob 504 Shaft 506 Housing 508 Screw part 510 Guide section 512 channels 514 Rib 516 Bore 518A Pull Wire 518B Pull Wire 520 slots 522 windows 550 Tensioning Mechanism 551 Handle Section 552 buttons 554 wedge 556 shaft 558 Housing 560A First pulley 560B Second pulley 562A First knob 562B Second Knob 564A Pull Wire Pair 564B Pull Wire Pair 600 Spring-loaded tensioning mechanism 602A pull wire 602B Pull Wire 604 Endoscope Controller 606 Handle Housing 608 Shaft 610 Actuator 612 Wheel 614 Lever 615A First Tensioner 615B Second tensioner 616 Knob 617 Operating Mechanism 618 buttons 620 Spring 622A Sagging 622B Sagging 623 Proximal end face 624A First Stop 624B Second Stop 625A Arc-shaped surface 625B Arc-shaped surface 626A Flange 626B Flange 628 Trough 650 Torsion Spring Tensioning Mechanism 652A pull wire 652B Pull Wire 654 Endoscope Controller 656 Handle Housing 658 Shaft 660 Actuator 662 wheels 664 Lever 666 Knob 670 drums 672 Torsion spring 674 Spindle 676 Actuating mechanism 678A Slot 678B Slot 680A First stop 680B Second stop 684A Sag 684B Sag 688 Proximal end face 690A Distal end 690B Proximal end 700 Rotatable tensioning mechanism 702A Pull wire 702B Pull wire 704 Endoscope controller 706 Handle housing 708 Shaft 710 Actuator 712 Wheel 714 Lever 716 Knob 717 Drum 718 Tensioner 719 Actuating mechanism 720 Shaft 722A Sag 722B Sag 723A First bearing 723B Second bearing 724 Proximal end face 726A Latch 726B Latch 750 Rotatable barrel tensioning mechanism [[ID=,67]]752 Knob component 754 Barrel component 756 Knob disk 758 Knob shaft 760 Clutch disk ?762 Knob 766 Stop slot 768 Clutch 770 Spring 772 Pivot 774 Extension 776 Barrel end wall 778 Barrel side wall 780 Post 782 Base 784 Clutch socket 786 Central part 788 Extension part 790 Stop 792 First opening 794 First groove 796 Pull wire 798 Slack 800 Rack and pinion tensioning mechanism 802A Pull wire 802B Pull wire 804 Endoscope controller 806 Handle housing 808 Shaft 810 Actuator 812 Wheel 814 Lever 816 Knob 822A Slack 822B Slack 824 Rack 826 Pinion 828 Shaft 830 Spring 832 Actuator 834 Proximal end face 900 Retention strap 902 Auxiliary scope 904 Primary scope 906 Shaft part 908 Handle 910 Actuator 912 Lever 914 Actuator 916 Groove 930 Packaging container 932 Tether 934 Anchor

Claims

1. Handpiece housing and A long, slender, flexible shaft extending from the handpiece housing, A pull wire extending from the handpiece housing into the elongated flexible shaft, A tensioning mechanism configured to adjust the tension in the pull wire, Includes, The tensioning mechanism is configured to adjust the position of the elongated flexible shaft relative to the handpiece housing in order to indirectly adjust the tension in the pull wire. The tensioning mechanism includes a rotatable hub positioned around the elongated flexible shaft, the tensioning mechanism includes a spiral slot inside the rotatable hub, and a pin provided on the elongated flexible shaft and configured to extend into the spiral slot. The rotatable hub is positioned outside the handpiece housing and connected to a rotatable strain relief positioned around the elongated flexible shaft. The rotation of the rotatable hub is configured to induce axial translation of the elongated flexible shaft by pushing the pin in the spiral slot. Endoscope.

2. The endoscope according to claim 1, further comprising a locking mechanism for maintaining the elongated flexible shaft in a distal position after the tensioning mechanism has been engaged.

3. The endoscope according to claim 1, further comprising an operating mechanism connected to the pull wire for pulling the pull wire independently of the tensioning mechanism.

4. The rotatable strain relief is positioned around the rotatable hub and is configured to be rotatable in order to guide the rotation of the rotatable hub. The endoscope according to claim 1.

5. A method for adjusting the tension in the pull wire of a controller for an endoscope according to any one of claims 1 to 4, The steps include preparing to use the endoscope before the procedure, A step of adjusting the tension in the pull wire in order to deflect the flexible elongated shaft of the endoscope in order to reduce knob dwell, Methods that include...

6. The method according to claim 5, wherein the step of adjusting the tension in the pull wire to deflect the flexible elongated shaft of the endoscope in order to reduce knob dwell includes the step of displacing the flexible elongated shaft.

7. The method according to claim 5, further comprising the step of setting a tensioning mechanism lock to maintain the tension in the pull wire.

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