Cannula-based two-stage deployment and retraction apparatus

Abstract

A cannula-based apparatus is provided that is configured to deploy a plurality of instruments from the distal end of a cannula, and to sequentially retract the plurality of instruments by retracting a single control wire from a proximal end of the cannula. The deployment and sequential retraction of the multiple instruments is achieved by providing various hubs (having a central open channel) and stops that are affixed to control wires attached to the instruments and to the lumen wall of the cannula. One such apparatus is a wire prong grasper, where a snare wire can first be retracted to collapse the extended prongs, followed by retraction of the collapsed prongs towards / into the distal end of the cannula.

Description

TITLECANNULA-BASED TWO-STAGE DEPLOYMENT AND RETRACTION APPARATUSCROSS-REFERENCE TO RELATED APPLICATION(S)

[0001] The present application relates to and claims priority from U.S. Provisional Patent Application Serial No. 63 / 562,658 filed March 7, 2024, the disclosure of which is incorporated herein by reference in its entirety.FIELD

[0002] The present disclosure relates to medical instruments that are deployable through a cannula or catheter, specifically deployment arrangements that provide for staged, sequential deployment and retraction of two or more functional elements from the distal end of a cannula using a single trigger or sliding mechanism.BACKGROUND

[0003] Certain medical devices, such as extractors and the like, typically include a functional instrument that can be deployed and retracted from the distal end of a cannula that is inserted into a pre-existing or surgically prepared opening or passage in a subject. This is typically configured with the instrument affixed to a cable or wire that runs through the cannula to the proximal end. The cannula and wire / cable are typically flexible to allow bending of the cannula assembly as it is advanced into a subject and withdrawn therefrom. A handle or grip affixed to the proximal end can include a retraction actuator, such as a trigger or a sliding ring or knob, which is affixed to the proximal end of the wire or cable.For the simpler example of a sliding control ring, the ring can be slid forward relative to the handle, which pushes the control wire toward the distal end of the cannula and deploying theinstrument from that end. By pulling the control ring back, the control wire can be pulled toward the proximal end of the cannula, thereby retracting the instrument toward or into the distal end of the cannula. In some such instruments, a trigger mechanism can be provided that is configured to advance and pull back the control wire through the cannula. Both the control rings and triggers can include additional features to make operation of the device easier, such as spring-loaded actuation, releasable locking mechanisms to hold the control ring or trigger in an advanced or retracted position, etc.

[0004] One common form of such devices is a cannula-based extractor or grasper, which is configured to extend grasping arms from the distal end of the cannula, grab an object, such as a food bolus, and hold onto it as the cannula is removed from a subject.Gastroenterologists can use such extractors, often in conjunction with an endoscope to better locate and capture the bolus for removal. Many conventional extraction devices employ a plurality of prongs extending from the end of a catheter or cannula that are biased outward and expand when the prongs are extended from the distal end of the cannula, and reconverge when the prongs are retracted into the distal end of the cannula due to the “pinching” effect of the small cannula opening. The proximal ends of the prongs are affixed to the control wire to allow the prongs to be advanced and retracted relative to the cannula using the control ring or trigger.

[0005] The prongs can be provided with hooks to better grab onto a food bolus or other object to pull it out. An example of such an extractor device, where the hooks are formed as small loops at the ends of the prong wires, is described in U.S. Patent No. 5,667,525. Similar extractors are also sold for household and workshop use to grab small objects that may be located in hard to reach areas, such as bolts, clips, small jewelry and the like, which may fall into plumbing drains, beneath open grates, into crevices of auto engines and other equipment,etc.

[0006] In medical uses, some extractors are also provided with a snare wire that loops around the ends of the prongs to improve ease of bolus capture. A flexible mesh or netting material can also be provided between the expanded prongs to better retain captured objects and reduce breakup of the objects. Examples of such snare extractors are described, e.g., in U.S. Patent Publication No. US 2016 / 0278797, in U.S. Patent Publication No. US 2015 / 0327876, and in U.S. Patent Publication No. US 16 / 764,798. In these snare extractors, the snare wire passes through an orifice at the end of each prong to form a continuous loop between the prong ends when they expand. As with the control cable, one or both ends of the snare wire passes through the cannula to the control handle. The proximal end(s) of the snare wire can be attached to a second control ring or trigger that is also part of the de vice handle.

[0007] When the prongs of a typical snare extractor are deployed from the distal end of a cannula and expand outward from the center axis, the snare wire also expands to form a widened loop between the prong tips. To grasp an object, the second control ring or trigger is activated or pulled back to pull the snare wire towards the handle at the proximal end of the cannula. This causes the snare loop between the prong tips to shrink, pulling the tips together to hold onto an object located between the prongs. When the snare loop is fully collapsed, or resistance due to the presence of an object impedes further retraction of the snare wire, the prongs can then be partially or fully retracted into the distal end of the cannula using the first trigger or control ring affixed to the control wire and prongs. The entire device can then be withdrawn from the subject while maintaining a hold onto the grasped object.

[0008] Although the addition of a snare loop to a pronged grasper can improve the capture effectiveness, it can be more difficult to manipulate because two control rings or triggers must be actuated sequentially to first collapse the snare and then retract the prongs.This can require the development of proper technique, often requiring the simultaneous operation of a capture mechanism and forward movement toward or past the object. Also, activation of the two controls in the wrong order can impair or defeat the capture of an object.

[0009] Accordingly, it may be desirable to provide a cannula-based device, such as a snare extractor or the like, that deploys and retracts two different functional objects at the distal end of a cannula sequentially, where such two-stage deployment and / or retraction has a simplified control arrangement for easier and more reliable operation of the device.SUMMARY

[0010] Embodiments of the disclosure can provide an apparatus configured to deploy a plurality of instruments from a distal end of a cannula, and to sequentially retract the plurality of instruments by retracting a single control wire from a proximal end of the cannula. This apparatus facilitates deployment of multiple instruments from the distal end of a cannula, and sequential (rather than simultaneous) retraction of the instruments back into the distal end of the cannula by retracting a single control wire from the proximal end of the cannula.

[0011] The apparatus can include a cannula having a lumen extending through the entire length thereof, and a cannula hub stop provided within the lumen that is affixed to an inner wall of the lumen, and the cannula hub stop includes an open cannula hub stop channel that passes through the entire length thereof.

[0012] The apparatus can further include a first retractable arrangement that includes a first support wire, a first instrument affixed to the distal end of the first support wire, and a first hub affixed to the proximal end of the first support wire. The first hub includes an open channel through the entire length thereof, and is sized to move slidably within the lumen of the cannula. The first hub is wider than the cannula hub stop channel, and the first support wire passes through the cannula hub stop channel and is configured to move slidably through it.The first hub is located within the cannula between the cannula hub stop and the proximal end of the cannula.

[0013] The apparatus can further include a second retractable arrangement that includes a second support wire, a second instrument affixed to the distal end of the second support wire, a retraction stop affixed to the second support wire, and a deployment stop affixed to the second support wire at a location closer to the proximal end of the cannula than the retraction stop. The second support wire extends beyond the proximal end of the cannula when the second instrument is deployed beyond the distal end of the cannula. The retraction stop is wider than the first hub channel and the cannula hub stop channel and the deployment stop is wider than the first hub channel. The retraction stop is positioned between the cannula hub stop and the first hub, and the first hub channel is positioned around the second hub wire between the retraction stop and the deployment stop.

[0014] The apparatus is configured to extend both the first instrument and the second instrument from the distal end of the cannula when the proximal end of the second support wire is advanced into the cannula from the proximal end of the cannula, and to retract the first instrument and the second instrument sequentially from the distal end of the cannula when the proximal end of the second support wire is retracted from the proximal end of the cannula. The cannula and control wires can be rigid but sufficiently flexible to allow them to bend or curve during deployment of the apparatus into a desired location, while providing mechanical stability to allow reliable translation of the various components during operation.

[0015] In some embodiments, the apparatus includes a snare grasper, where the first instrument is a pronged grasper that includes a plurality of wire prongs affixed to the distal end of the first support wire, and the second instrument is a flexible wire snare affixed to the distal end of the second support wire, where the flexible wire snare passes through each of a plurality of apertures provided at the distal ends of each of the wire prongs.

[0016] In additional embodiments, the apparatus further includes a control arrangement affixed to the proximal end of the cannula that is configured to controllably advance and retract the proximal end of the second control wire through the proximal end of the cannula to deploy and sequentially retract both the first and second instruments from the distal end of the cannula. The control arrangement can include a trigger arrangement that advances and retracts the second control wire relative to the proximal end of the cannula. In other embodiments, the control arrangement can include a slidable control ring or sleeve that advances and retracts the second control wire relative to the proximal end of the cannula. In still further embodiments, the control arrangement can include any mechanical arrangement that is capable of advancing and retracting the second control wire relative to the proximal end of the cannula

[0017] The apparatus can be configured to advance and retract the proximal end of the second control wire relative to the proximal end of the cannula by a predetermined distance based on the configuration of the control arrangement and various hubs and stops.

[0018] In still further embodiments, the apparatus can include three or more deployable / retractable instruments, where the plurality of instruments can be sequentially retracted by withdrawing a single control wire from the proximal end of the cannula. The interval between sequential retraction of the instruments and their deployment distances from the distal end of the cannula can be determined by the spacing and sizing of the various hubs, stops, and channels passing through the hubs.BRIEF DESCRIPTION OF DRAWINGS

[0019] Further objects, features and advantages of the present disclosure will become apparent from the following detailed description taken in conjunction with the accompanying figures showing illustrative embodiments, results and / or features of the exemplary embodiments of the present disclosure, in which:

[0020] FIG. 1A illustrates an exemplary prong arrangement that can be used with a snare grasper device in accordance with certain embodiments of the disclosure;

[0021] FIG. IB illustrates a snare arrangement that can be used with the exemplary snare grasper device;

[0022] FIG. 1C illustrates a cannula that forms the main body of the exemplary snare grasper device;

[0023] FIG. ID illustrates an assembled 2-stage snare grasper device containing the prong arrangement, snare arrangement, and catheter of FIGS. 1 A-1C, in accordance with certain embodiments of the disclosure;

[0024] FIG. 2A illustrates the 2-stage snare grasper device shown in FIG. ID prior to deployment of the grasper end;

[0025] FIG. 2B illustrates the 2-stage snare grasper device shown in FIG. ID with the grasper end deployed from the distal end of the cannula; and

[0026] FIG. 2C illustrates the 2-stage snare grasper device shown in FIG. ID with the snare wire retracted, prior to retraction of the grasper end.

[0027] While the present disclosure will now be described in detail with reference to the figures, it is done so in connection with the illustrative embodiments and is not limited by the particular embodiments illustrated in the figures. It is intended that changes and modifications can be made to the described embodiments without departing from the true scope and spirit of the present disclosure as defined by the appended claims. It is also noted that any trademarks, trade names, or other proprietary identifiers shown in the figures are for illustrative purposes only, and do not imply any affiliation or agreement between the owners of such identifiers and the Applicant submitting the present disclosure.DETAILED DESCRIPTION

[0028] Embodiments of the present disclosure provide systems and mechanisms for sequential deployment and / or retraction of two instruments or components from the distal end of a cannula or catheter, using only a single control at the proximal end of the cannula, such as a trigger mechanism or a sliding knob or ring. The use of single activation mechanism for such a device simplifies the operation of the device, and also ensures proper staged or successive deployment and / or retraction of the two components. For example, the disclosed systems guarantee that the two components are deployed in the proper order, and also that they are deployed / retracted to the desired distance or extent. Use of a single activating arrangement also provides reliable control of the device using a single hand when the device contains two instruments.

[0029] In one exemplary embodiment, a staged deployment / retraction system can be used to deploy a snare grasper such as those described herein, and sequentially collapse the snare (and prong tips), followed by retraction of the prongs into the distal end of the cannula. This exemplary system for a snare grasper 100 is illustrated in FIGS. 1A-1D, the features of which are described in detail below.

[0030] FIG. 1 A illustrates an exemplary prong arrangement 110, which includes a plurality of prongs 112 affixed to a first end of a prong arm 116. The distal ends of the prongs 112 can include orifices or apertures 114 configured to allow a snare wire to pass therethrough. The apertures 1 14 can be, e.g., holes provided near the distal ends of the prongs 1 12, loops formed at the distal ends of the prongs 112, and the like. A hub 118 is affixed to the second end of the prong arm 116. A central channel or opening is provided through the length of the hub 118. The prongs 1 12, prong arm 116, and hub 118 can be made from any of a variety of materials, including metal (e.g., wires), plastics or polymers, etc.

[0031] FIG. IB illustrates a snare arrangement 120 that can be used in the snare grasper100. A snare loop 122 is affixed to the distal end of a control wire 124 that is sized to extend through the length of the cannula 130 shown in FIG. 1C. A retractor stop 126 and a deployment stop 128 are affixed to the control wire 124 at a particular distance behind the snare loop 122, with a predetermined distance between them. Each of the retractor stop 126 and deployment stop 128 are secured so they do not slide along the control wire 124, and remain at their initial locations on the control wire 124. The retractor stop 126 and deployment stop 128 each have a width or diameter that is larger than that of the control wire 124.

[0032] The snare loop 122, control wire 124, retractor stop 126, and deployment stop 128 can each be made from any of a variety of materials, including metal (e.g., wires), plastics or polymers, etc. In some embodiments, if the control wire 124 is a plastic or polymer material, the retractor stop 126 and / or deployment stop 128 can be formed from the same material as enlarged or widened segments of the control wire 124.

[0033] FIG. 1C illustrates a cannula or catheter 130 that forms the main body of the snare grasper 100. The cannula can be provided in the form of a hollow tube having a central open passage, or lumen, that extends from the proximal end to the distal end of the cannula. This can be formed of any material commonly used for conventional cannulas and catheters, and can have any desired length, inner diameter, and outer diameter. Such cannulas 130 are typically made of a flexible material to facilitate their insertion and traversal through any orifices or passages during use, although a rigid material can also be used for the cannula 130 in certain embodiments.

[0034] A hub stop 132 is provided within the hollow central passage, or lumen, of the catheter 130, and is affixed to an inner wall thereof such that it remains in a fixed position relative to the distal end of the catheter 130. An opening or channel is provided through the entire length of the hub stop 132, where this opening is preferably substantially parallel to the central axis of the cannula 130.

[0035] The assembled snare grasper 100, containing the prong arrangement 110, snare arrangement 120, and catheter 130 is illustrated in FIG. ID. The snare arrangement 120 is positioned such that the snare loop 122 is located at the distal end of the cannula 130, with the control wire 124 passing through the length of the catheter 130 to the proximal end thereof. The snare loop 122 passes through the apertures 114 at the ends of the prongs 112, forming a closed loop that encircles the prong ends. The snare loop 122 is slidably engaged with the prong ends, such that it can freely slide through each of the apertures 114.

[0036] For clarity, the activation mechanism located at the proximal end of the cannula 130 is not illustrated here. However, this mechanism can include a conventional handle, grip, or he like affixed to the proximal end of the catheter 130, and can include a conventional trigger arrangement, sliding control ring or knob, or the like, that is configured to controllably advance and retract the control wire 124 within the cannula 130.

[0037] The prong arrangement 110 is also located near the distal end of the cannula 130, with the prong arm 116 provided within the central opening of the cannula 130. The control wire 124 passes through the central channel of the hub 118, such that the hub 118 is positioned between the retractor stop 126 and deployment stop 128. The opening or channel through the hub 118 is sized such that the control wire 124 can pass through it freely, but is small enough to prevent passage of the retractor stop 126 and deployment stop 128 therethrough.

[0038] The opening through the hub stop 132 is sized large enough to allow free passage of the control wire 124, retractor stop 126, and deployment stop 128 therethrough, but is small enough to prevent the hub 118 from passing through it.

[0039] Operation of the exemplary snare grasper 100 is illustrated in FIGS. 2A-2C. FIG. 2A shows the snare grasper 100 with the snare grasper assembly fully retracted into thedistal portion of the cannula 130. This retracted configuration allows the snare grasper 100 to be deployed easily into a natural or surgically prepared opening, or a passageway, of the subject such that the distal end can be positioned near an object to be grasped and extracted.

[0040] FIG. 2B illustrates the deployed position of the snare grasper 100. To achieve this position, the control wire 124 is advanced through the cannula 130 from the proximal end thereof towards the distal end, e.g., using an activating arrangement such as a trigger or a sliding ring or knob. As the control wire 124 is advanced, the snare loop 122 and coupled prongs 112 extend forward from the distal end of the cannula 130. The deployment stop 128 abuts the proximal end of the hub 118 as the control wire 124 advances, then pushes the entire prong arrangement 110 toward the distal end of the cannula 130. As the control wire 124 advances further, the prongs 112 exit the distal end of the cannula and spread outward from the central axis of the cannula 130 due to their preformed outward bias. The snare loop 122 also expands as the prongs 112 spread apart, forming the looped snare configuration shown in FIG. 2B.

[0041] The advancement of the prong arrangement 110 stops when the hub 118 reaches the hub stop 132, preventing further forward motion of the prong arrangement 110. This also stops further advancement of the control wire 124, as the deployment stop 128 is blocked by the hub 118, which is blocked from advancing further by the hub stop 132, when the prong arrangement 110 is fully advanced. The maximum distance to which the prongs 112 will extend from the distal end of the cannula 130, and the degree to which the snare loop 122 will also deploy, can be predetermined by appropriate positioning of the hub 118 within the cannula 130, and of the deployment stop 128 on the control wire 124, as well as the length of the prong arm 1 16. In this extended configuration, the snare grasper 100 can be guided such that the object to be extracted is at least partially within the “cage” formed by the extended prongs 112 and snare loop 122.

[0042] Capture of the object is performed by retracting the control wire at the proximal end of the cannula 130, e.g., using the activation mechanism (e.g., trigger, sliding ring, sliding knob, or the like). Initially, retraction of the control wire 124 toward the proximal end of the cannula will pull the snare loop 122 back, causing the snare loop 122 to converge the tips of the prongs 112 together and securing the captured object between the converged prongs 112. The prongs 112 themselves will resist being drawn back into the cannula 130 due to their outward bias while they are at least partially spread apart.

[0043] As the control wire 124 is retracted further, the retraction stop 126, which can freely move through the opening or channel in the hub stop 132, will pass therethrough and contact the distal end of the hub 118. Further retraction of the control wire 124 will retract the prong arrangement 110 into the distal end of the cannula 130 as the retraction stop 126 pushes the hub 118 towards the proximal end of the cannula 130. The fully retracted state, which is the same as the initial deployment state, is shown in FIG. 2A.

[0044] If an object is captured between the prongs 112, this may inhibit full collapse of the prong arms 112 as the object may prevent the prong tips from being drawn together by the snare loop 122 as illustrated in FIG. 2C. In this situation, retraction of the control wire 124 will meet resistance as the prongs 112 and / or snare loop 122 converge on the captured object, preventing further retraction of the distal grasper assembly into the distal end of the cannula 130. When such resistance is felt, the entire snare grasper 100 can then be withdrawn from the subject together with the captured object.

[0045] The extent to which the control wire 124 can be withdrawn from the proximal end of the cannula 130 can be controlled by appropriate configuration of the activation mechanism, which can be used constructed to provide a predetermined range of motion of the control wire 124 relative to the cannula 130. Preferably, the prong arrangement 110 will be at or close to the distal end of the cannula 130 in the fully retracted state. In a furtherembodiment (not illustrated), a deployment limiter, having a similar configuration as the hub 118, can be affixed to the interior of the cannula 130 closer to the proximal end of the cannula 130. The deployment limiter can have a passage therethrough that allows the control wire 124 to move through it freely, with the channel being sized small enough to prevent passage of the deployment stop 128 through it. Appropriate placement of such a deployment limiter can limit the extent to which the control wire 124 can be withdrawn from the proximal end of the cannula 130.

[0046] The exemplary apparatus described above and illustrated in FIGS. 1 and 2 provide a grasping apparatus that can deploy a set of prongs 112 and coupled snare loop 122 from the distal end of a cannula 130 by advancing a single control wire 124 from the proximal end of the cannula 130. This exemplary system can also provide a two-stage retraction of the grasping mechanism that first retracts the snare loop 122, causing the ends of the prongs 112 to converge, and subsequently retracting the converged prongs 112 into the distal end of the cannula 130, by continuously withdrawing the control wire 124 from the proximal end of the cannula 130.

[0047] This two-stage deployment / retraction system can provide simpler, easier, and more reliable operation of snare graspers and similar devices that utilize separate deployment and / or retraction of two instruments through a cannula, as compared to conventional devices that require two separate controls to perform these operations. The disclosed system can provide limits on the deployment and retraction distances of each instrument, as well as ensure proper sequencing of the two operations via a single activating mechanism, using appropriate sizing and spacing of the various components illustrated in FIGS. 1A-1D.

[0048] The snare grasper 100 described herein provides a single deployment process and a sequential two-stage retraction process using a single activating arrangement to advance and retract a single control wire 124 through a cannula 130. In further embodiments, thedisclosed system can also be used to provide a two-stage deployment operation to deploy two instruments sequentially from a cannula, where the instruments are not coupled to each other as the snare loop 122 and prongs are. In these embodiments, the first instrument to be deployed can be affixed to the distal end of the control wire 124 in a component similar to the snare arrangement 120 shown in FIG. IB. The second instrument can be provided instead of the prongs 122 at the distal end of a component structured similarly to the prong arrangement 110 shown in FIG. 1 A. (The second instrument can also comprise a plurality of prongs 112, or any other deployable instrument that can fit inside the cannula 130.)

[0049] In these embodiments, the second instrument can optionally be sized such that there is some frictional resistance against motion relative to the interior walls of the cannula 130. In operation, with both instruments initially retracted into the cannula 130, as shown in FIG. 2A, advancing the control wire 124 (e.g., using an activating mechanism or arrangement at the proximal end of the cannula 130) can deploy the first instrument from the distal end of the cannula 130. The second instrument will remain retracted inside the cannula 130 as the control wire 124 freely passes through the hub 118 to deploy the first instrument.

[0050] Once the first instrument is partially or fully deployed, the components of the system can be spaced such that the deployment stop 128 contacts the hub 118 coupled to the second instrument. Further advancement of the control wire 124 will cause the deployment stop 128 to push the hub 118 towards the distal end of the cannula 130, deploying the second instrument coupled to the hub 118 by a prong arm 116 or similar component. This deployment can continue with further advancement of the control wire 124 until the deployment stop 128 reaches the hub stop 132, preventing further forward motion of the hub 118 and second instrument. In this manner, controlled sequential deployment of two instruments from a cannula 130 can be achieved by advancing a single control wire 124 through the cannula 130, with ranges of motion of the two instruments and timing of their relative deployment beingcontrollable by appropriate sizing and placement of the prong arm 116, hub 118, hub stop 132, retraction stop 126, and deployment stop 128.

[0051] This exemplary configuration can also provide staged retraction of both instruments, in a manner similar to that described herein for the snare grasper 100. For example, when both instruments are deployed, retracting the control wire 124 towards the proximal end of the cannula 130 will retract the first instrument, which is coupled to the control wire 124. The second instrument will remain deployed as the control wire 124 freely passes through the hub 118 while the first instrument is retracted. Upon further retraction of the control wire 124, the retraction stop 126 will contact the distal end of the hub 118, pulling the hub 118 and the second instrument coupled to it towards the proximal end of the cannula 130 and retracting the second instrument into the cannula 130.

[0052] In yet another embodiment, both instruments can be deployed together by providing the deployment stop 128 in contact with the proximal end of the hub 118 when both instruments are in the initial retracted position within the cannula 130. Advancing the control wire 124 within the cannula 130 will then advance both instruments together as the deployment stop 128 affixed to the control wire 124 pushes the hub 118 (and the second instrument) forward while the first instrument is being deployed directly by the control wire 124. Sequential retraction of the first instrument followed by the second instrument can then be performed in the same manner as described herein for the snare grasper 100, where the location of the retraction stop 126 on the control wire 124 will provide a delay when retracting the first instrument, until the control wire 124 is retracted sufficiently such that the retraction stop 126 pulls the hub 118 back to retract the second instrument.

[0053] In yet further embodiments, both two-stage (sequential) deployment and 2-stage retraction of two instruments can be achieved by combining the above embodiments. In these embodiments, the first instrument will be directly deployed / withdrawn byadvancing / withdrawing the control wire 124, and delayed deployment / retraction of the second instrument can be achieved by appropriate positioning of the deployment stop 128 and retraction stop 126 on the control wire. All of this can be operated by a single activating mechanism that advances and withdraws the single control wire 124. Again, ranges of motion of the two instruments and timing of their relative deployment can be controlled by appropriate sizing and placement of the prong arm 116, hub 118, hub stop 132, retraction stop 126, and deployment stop 128.

[0054] In yet further embodiments, three or more instruments can be sequentially deployed and / or retracted using a similar system as described herein. Two or more instruments can be affixed to a component similar to the prong arrangement 110 illustrated in FIG. 1 A.The hubs 118 associated with the different instrument components can have differing channel sizes therethrough, and multiple deployment and / or retraction stops having different sizes or widths can be affixed to the control wire 124, such that at least one such stop is sized to pass through the channel of at least one hub but not through another hub. The channel through the fixed hub stop is sized to allow passage therethrough of all stops that are affixed to the control wire 124 and are associated with the two or more instruments not directly affixed to the control wire 124. It is a straightforward design exercise, based on the embodiments described herein, to size and space the hubs and hub channels (including the channels that run through them), and plurality of stops to achieve any desired sequencing and distances of advancement and / or retraction for multiple instruments from a single cannula 130 by advancing and retracting a single control wire 124.

[0055] The foregoing merely illustrates the principles of the exemplary embodiments of the present disclosure, including general features and organization of the network system and associated apps, and the various features provided to and used by end users. Many specific examples are described to illustrate the various features and functions of the network systemand associated apps. Other variations and combinations of these exemplary embodiments, and the application of the general features and functions described herein to achieve other results and / or effects, can be understood and effected by those skilled in the art in practicing the disclosed systems and methods from a study of the drawings and the present disclosure. The mere fact that certain features are described in different paragraphs and / or illustrated in different figures does not indicate that any combination of these features cannot be used advantageously. Various modifications and alterations to the described exemplary embodiments will be apparent to those skilled in the art in view of the teachings herein. It will thus be appreciated that those skilled in the art will be able to devise numerous techniques which, although not explicitly described herein, embody the principles of the invention and are thus within the spirit and scope of the present disclosure. Also, all patents, patent publications, and other publications referenced or cited in this disclosure are incorporated herein in their entireties.

Claims

WHAT IS CLAIMED IS:

1. An apparatus configured to deploy a plurality of instruments from a distal end of a cannula, and to sequentially retract the plurality of instruments by retracting a single control wire from a proximal end of the cannula, comprising: a cannula comprising a lumen extending through the entire length thereof, and a cannula hub stop provided within the lumen that is affixed to an inner wall thereof, wherein the cannula hub stop comprises a cannula hub stop channel through the entire length thereof; a first retractable arrangement comprising a first support wire, a first instrument affixed to a distal end of the first support wire, and a first hub affixed to a proximal end of the first support wire, wherein: the first hub comprises a first hub channel through the entire length thereof; the first hub is sized to move slidably within the lumen of the cannula; the first hub is wider than the cannula hub stop channel; the first support wire passes through the is cannula hub stop channel and is configured to move slidably through the cannula hub stop channel; and the first hub is located within the cannula between the cannula hub stop and the proximal end of the cannula, a second retractable arrangement comprising a second support wire, a second instrument affixed to a distal end of the second support wire, a retraction stop affixed to the second support wire, and a deployment stop affixed to the second support wire at a location closer to the proximal end of the cannula than the retraction stop, wherein: the second support wire extends beyond the proximal end of the cannula when the second instrument is deployed beyond the distal end of the cannula; the retraction stop is wider than the first hub channel and the cannula hub stopchannel; the deployment stop is wider than the first hub channel; the retraction stop is positioned between the cannula hub stop and the first hub; and a portion of the second hub wire between the retraction stop and the deployment stop passes slidably through the first hub channel, wherein the apparatus is configured to extend both the first instrument and the second instrument from the distal end of the cannula when the proximal end of the second support wire is advanced into the cannula from the proximal end of the cannula, and wherein the apparatus is further configured to retract the first instrument and the second instrument sequentially from the distal end of the cannula when the proximal end of the second support wire is retracted from the proximal end of the cannula.

2. The apparatus of claim 1 , wherein the first instrument comprises a grasper that comprises a plurality of wire prongs affixed to the distal end of the first support wire, and the second instrument comprises a flexible wire snare affixed to the distal end of the second support wire, wherein: an aperture is provided at a distal end of each of the plurality of wire prongs, and the flexible wire snare passes through each of a plurality of apertures.

3. The apparatus of claim 1, further comprising a control arrangement affixed to the proximal end of the cannula, wherein the control arrangement is configured to controllably advance and retract the proximal end of the second control wire through the proximal end of the cannula.

4. The apparatus of claim 3, wherein the control arrangement comprises a trigger arrangement.

5. The apparatus of claim 3, wherein the control arrangement comprises a control sleeve affixed to the proximal end of the second control wire and configured to be slidably moved back and forth relative to the proximal end of the cannula.

6. The apparatus of claim 3, wherein the control arrangement is configured to retract the proximal end of the second control wire only to a predetermined distance beyond the proximal end of the cannula.

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