Medical scopes and methods of using a medical scope

Abstract

An example medical scope has an outer elongated member, an inner elongate member, a distal tip, a handle, and a wire member. The outer elongate member has a first end, a second end, and a circumferential wall that extends between the first end and the second end. The circumferential defines an inner lumen and an indentation. The inner elongate member extends within the inner lumen. The inner elongate member has a first axial portion, a second axial portion disposed circumferentially adjacent to the indentation, and defines an inner elongate member lumen. The distal tip is attached to the outer elongate member and the inner elongate member. The handle is disposed on the first end of the outer elongate member and includes an actuator. The wire member is attached to the actuator and the distal tip. The wire member extends partially through the inner lumen and radially outward of the indentation.

Description

Medical Scopes and Methods of Using a Medical ScopeField

[0001] The disclosure relates generally to the field of medical devices and associated methods. More particularly, the disclosure relates to medical scopes and methods of using a medical scope.Background

[0002] Current treatments for nephrolithiasis, or the presence of urinary tract stones, can range from surgical procedures to allowing the stones to pass naturally, depending on the severity of the condition. Generally, stones smaller than 5mm can be passed with no internal intervention out of the urethra, but most stones larger than 5mm require additional intervention from a urologist. Primary interventional strategies for stone removal include ureteroscopy, percutaneous nephrolithotomy, and extracorporeal shockwave lithotripsy.

[0003] Ureteroscopy is a minimally invasive procedure that removes the stones by accessing the urinary tract through the urethra and bladder, which is sometimes accomplished using an access sheath. A flexible ureteroscope is passed through the sheath and into the renal pelvis, and further into individual calyces, to locate the stones. If a stone is small, removal can be accomplished using a basket or gasper. However, if the stone is large, lithotripsy is performed to fragment or dust the stone. In one example, laser lithotripsy is accomplished by passing a laser fiber through a working channel of the ureteroscope, which is used to fragment or dust the stone.

[0004] Irrigation is supplied to the treatment site throughout the procedure and accomplishes many goals, such as expanding the renal cavity, managing heat, clearing the field of view, and passively removing stone particles through the access sheath. Alternatively, stone particles can be removed using a stone extractor basket or grasper. Many devices only utilize one channel, or shared channels, to supply irrigation and pass treatment devices (laser, stone retrieval basket, etc.) to a point of treatment. In addition, many devices fail to provide a mechanism for applying suctionto remove stone particles while concurrently applying irrigation. As a result, the time required to perform a procedure is extended so stone particles can be removed from the field of view and the bodily passage.

[0005] A need exists, therefore, for new and useful medical scopes and methods of using a medical scope.Summary of Selected Example Embodiments

[0006] Various example medical scopes and methods of using a medical scope are described herein.

[0007] An example medical scope includes an outer elongate member, an inner elongate member, a distal tip, a handle, and a wire member. The outer elongate member has a lengthwise axis, a first end, a second end, and a circumferential wall that extends between the first end and the second end. The circumferential wall defines an inner lumen and an indentation. The inner elongate member extends within the inner lumen. The inner elongate member has a central axis, a first axial portion, a second axial portion disposed circumferentially adjacent to the indentation, and defines an inner elongate member lumen. The central axis along the first axial portion is disposed on a first axis. The central axis along the second axial portion is disposed on a second axis that is different than the first axis. The distal tip is attached to the outer elongate member and the inner elongate member. The handle is disposed on the first end of the outer elongate member. The handle includes an actuator. The wire member is attached to the actuator and the distal tip. The wire member extends partially through the inner lumen and radially outward of the indentation.

[0008] Additional understanding of these example medical scopes and methods of using a medical scope can be obtained by review of the detailed description, below, and the appended drawings.Brief Description of the Drawings

[0009] FIG. 1 is an isometric view of a first example medical scope.

[0010] FIG. 2 is a partial side view of the medical scope shown in FIG. 1 in a substantially straight configuration, in a first deflected configuration, and in a second deflected configuration. The jacket is removed for clarity.

[0011] FIG. 3 is a partial side view of the handle of the medical scope shown in FIG. 1.

[0012] FIG. 4 is a partial top view of the handle of the medical scope shown in FIG. 1.

[0013] FIG. 5 is a partial side view of the distal tip of the medical scope shown in FIG. 1.

[0014] FIG. 6 is another partial side view of the distal tip of the medical scope shown in FIG. 1.

[0015] FIG. 7 is a partial end view of the distal tip of the of the medical scope shown in FIG. 1.

[0016] FIG. 8 is a partial exploded isometric view of the distal tip of the medical scope shown in FIG. 1.

[0017] FIG. 9 is a partial isometric view of the second end of the medical scope shown in FIG. 1 and shows fluid flow patterns during use of the medical scope. The jacket of the outer elongate member has been omitted for clarity.

[0018] FIG. 10 is a partial top view of the first portion of the tubular shaft of the outer elongate member.

[0019] FIG. 11 is a partial top view of the second portion of the tubular shaft of the outer elongate member.

[0020] FIG. 12 is a partial top view of the third portion of the tubular shaft of the outer elongate member.

[0021] FIG. 13 is a partial top view of the fourth portion of the tubular shaft of the outer elongate member.

[0022] FIG. 14 is a partial isometric view of the tubular shaft of the outer elongate member.

[0023] FIG. 15 is another partial isometric view of the tubular shaft of the outer elongate member showing the first side.

[0024] FIG. 16 is another partial isometric view of the tubular shaft of the outer elongate member showing the second side.

[0025] FIG. 17 is a partial section view of the second end of the medical scope shown in FIG. 1.

[0026] FIG. 18 is a cross-sectional view of the medical scope shown in FIG. 1 taken along line A-A.

[0027] FIG. 19 is a partial isometric view of the handle of the medical scope shown in FIG. 1. A portion of the handle is removed for clarity.

[0028] FIG. 20 is a partial isometric view of the handle of the medical scope shown in FIG. 1.

[0029] FIG. 21 is a partial isometric view of the baffle of the medical scope shown in FIG. 1. A portion of the baffle has been removed for clarity.

[0030] FIG. 22 is a partial sectional view of the handle of the medical scope shown in FIG. 1.

[0031] FIG. 23 is an isometric view of the bung of the medical scope shown in FIG. 1.

[0032] FIG. 24 is an isometric view of the manifold of the medical scope shown in FIG. 1.

[0033] FIG. 25 is a sectional view of the manifold of the medical scope shown in FIG. 1.

[0034] FIG. 26 is an isometric view of the steering drum of the medical scope shown in FIG. 1.

[0035] FIG. 27 is another isometric view of the steering drum of the medical scope shown in FIG. 1.

[0036] FIG. 28 illustrates a first stiffness profile for an example outer elongate member.

[0037] FIG. 29 illustrates a second stiffness profile for an example outer elongate member.

[0038] FIG. 30 illustrates a third stiffness profile for an example outer elongate member.

[0039] FIG. 31 is a partial isometric view of an alternative handle that can be included on a medical scope.

[0040] FIG. 32 is another partial isometric view of the handle shown in FIG. 31 .

[0041] FIG. 33 is a partial exploded isometric view of the second end of a second example medical scope.

[0042] FIG. 34 is a partial isometric view of the second end of the medical scope shown in FIG. 33.

[0043] FIG. 35 is a partial end view of the medical scope shown in FIG. 33.

[0044] FIG. 36 is a partial isometric view of the frame and chassis of the medical scope shown in FIG. 33.

[0045] FIG. 37 is a partial isometric view of the handle of the medical scope shown in FIG. 33. A portion of the handle is removed for clarity.

[0046] FIG. 38 is a partial isometric view of the chamber of the medical scope shown in FIG. 33.

[0047] FIG. 39 is another partial isometric view of the chamber of the medical scope shown in FIG. 33.

[0048] FIG. 40 is a partial view of the steering drum of the medical scope shown in FIG. 33.

[0049] FIG. 41 is a partial view of the actuator of the medical scope shown in FIG. 33.

[0050] FIG. 42 is a partial isometric view of the second end of a third example medical scope.

[0051] FIG. 43 is a partial side view of the second end of the medical scope shown in FIG. 42.

[0052] FIG. 44 is a partial exploded isometric view of the second end of the medical scope shown in FIG. 42.

[0053] FIG. 45 is a partial isometric view of the frame and chassis of the medical scope shown in FIG. 42.

[0054] FIG. 46 is a partial isometric view of a fourth example medical scope.

[0055] FIG. 47 is a partial side view of the second end of the medical scope shown in FIG. 46 in a substantially straight configuration

[0056] FIG. 48 is a partial side view of the second end of the medical scope shown in FIG. 46 in a first deflected configuration.

[0057] FIG. 49 is a magnified isometric view of the second end of the medical scope shown in FIG. 46.

[0058] FIG. 50 is another magnified isometric view of the second end of the medical scope shown in FIG. 46.

[0059] FIG. 51 is a cross-sectional isometric view of the medical scope shown in FIG. 46 taken along line B-B.

[0060] FIG. 52 is a partial isometric view of the second end of the tubular shaft of the medical scope shown in FIG. 46.

[0061] FIG. 53 is a top view of the tubular shaft of the medical scope shown in FIG. 46.

[0062] FIG. 54 is a partial view of the tubular shaft of the medical scope shown in FIG. 46.

[0063] FIG. 55 is a partial sectional view of the handle of the medical scope shown in FIG. 46.

[0064] FIG. 56 is a partial sectional view of the handle of the medical scope shown in FIG. 46.

[0065] FIG. 57 is an isometric view of the suction control of the medical scope shown in FIG. 46. The actuator of the suction control is shown in a first position.

[0066] FIG. 58 is another isometric view of the suction control of the medical scope shown in FIG. 46. The actuator of the suction control is shown in a second position.

[0067] FIG. 59 is an isometric view of the hub of the medical scope shown in FIG. 46.

[0068] FIG. 60 is a partial sectional isometric view of the handle of the medical scope shown in FIG. 46.

[0069] FIG. 61 is a partial sectional view of the hub of the medical scope shown in FIG. 46.

[0070] FIG. 62 is another partial sectional view of the hub of the medical scope shown in FIG. 46.

[0071] FIG. 63 is a partial isometric view of the second end of the medical scope shown in FIG. 46.

[0072] FIG. 64 is a partial isometric view of the distal tip of the medical scope shown in FIG. 46.

[0073] FIG. 65 is a schematic representation of an example method of using a medical scope.

[0074] FIG. 66 is a partial side view of a medical scope disposed within a urinary tract.

[0075] FIG. 67 is a partial side view of a medical scope disposed within a renal cavity. Irrigation and suction are being applied within the renal cavity concurrently.

[0076] FIG. 68 is an isometric view of an alternative distal tip that can be included in a medical scope.

[0077] FIG. 69 is another isometric view of the distal tip shown in FIG. 68.

[0078] FIG. 70 is an isometric view of another alternative distal tip that can be included in a medical scope.

[0079] FIG. 71 is an isometric view of another alternative distal tip that can be included in a medical scope.

[0080] FIG. 72 is an end view of the distal tip shown in FIG. 71 included on a medical scope.

[0081] FIG. 73 is a partial isometric view of the distal tip shown in FIG. 72.

[0082] FIG. 74 is an isometric view of another alternative distal tip that can be included in a medical scope.

[0083] FIG. 75 is an isometric view of another alternative distal tip that can be included in a medical scope.

[0084] FIG. 76 is an isometric view of another alternative distal tip that can be included in a medical scope.

[0085] FIG. 77 is another isometric view of the distal tip shown in FIG. 76.

[0086] FIG. 78 is an isometric view of another alternative distal tip that can be included in a medical scope.

[0087] FIG. 79 is an isometric view of another alternative distal tip that can be included in a medical scope.

[0088] FIG. 80 is another isometric view of the distal tip shown in FIG. 79.

[0089] FIG. 81 is an isometric view of another alternative distal tip that can be included in a medical scope.

[0090] FIG. 82 is another isometric view of the distal tip shown in FIG. 81.

[0091] FIG. 83 is an isometric view of another alternative distal tip that can be included in a medical scope.

[0092] FIG. 84 is another isometric view of the distal tip shown in FIG. 83.

[0093] FIG. 85 is an isometric view of another alternative distal tip that can be included in a medical scope.

[0094] FIG. 86 is another isometric view of the distal tip shown in FIG. 85.

[0095] FIG. 87 is an isometric view of another alternative distal tip that can be included in a medical scope.

[0096] FIG. 88 is another isometric view of the distal tip shown in FIG. 87.

[0097] FIG. 89 is a partial isometric view of a fifth example medical scope.

[0098] FIG. 89A is a magnified view of a portion of the medical scope shown in FIG. 89 with portions of the medical scope removed for clarity.

[0099] FIG. 89B is another magnified view of a portion of the medical scope shown in FIG. 89 with portions of the medical scope removed for clarity.

[0100] FIG. 90 is a partial top view of the handle of the medical scope shown in FIG. 89.

[0101] FIG. 91 is a partial bottom view of the handle of the medical scope shown in FIG. 89.

[0102] FIG. 92 is a partial side view of the handle of the medical scope shown in FIG. 89.

[0103] FIG. 93 is another partial side view of the handle of the medical scope shown in FIG. 89.

[0104] FIG. 94 is an end view of the medical scope shown in FIG. 89.

[0105] FIG. 95 is another end view of the medical scope shown in FIG. 89.

[0106] FIG. 96 is a partial isometric sectional view of the handle of the medical scope shown in FIG. 89.

[0107] FIG. 97 is another partial isometric sectional view of the handle of the medical scope shown in FIG. 89. Some components of the medical scope have been omitted for clarity.

[0108] FIG. 98 is another partial isometric sectional view of the handle of the medical scope shown in FIG. 89. Some components of the medical scope have been omitted for clarity.

[0109] FIG. 99 is a partial isometric view of the distal tip of the medical scope shown in FIG. 89.

[0110] FIG. 100 is a partial isometric view of an end the medical scope shown in FIG. 89. The distal tip has been removed for clarity.

[0111] FIG. 101 is a partial isometric sectional view of the distal tip of the medical scope shown in FIG. 89.

[0112] FIG. 102 is a partial isometric view of the distal tip of the medical scope shown in FIG. 89.

[0113] FIG. 103 is another partial isometric view of the distal tip of the medical scope shown inFIG. 89.

[0114] FIG. 104 is an isometric exploded view of the distal tip of the medical scope shown in FIG. 89 free of the outer elongate member and the inner elongate member.

[0115] FIG. 105 is another isometric view of the distal tip shown in FIG. 104.Detailed Description of Selected Examples

[0116] The following detailed description and the appended drawings describe and illustrate various example embodiments of medical scopes and methods of using a medical scope. The description and illustration of these examples are provided to enable one skilled in the art to make and use a medical scope and practice a method of using a medical scope. They are not intended to limit the scope of the claims in any manner. The invention is capable of being practiced or carried out in various ways and the examples described and illustrated herein are merely selected examples of the various ways of practicing or carrying out the invention and are not considered exhaustive.

[0117] FIGS. 1 through 27 illustrate a first example medical scope 10 that has a first end 12, a second end 14, an outer elongate member 16, an inner elongate member 18, a handle 20, a distal tip 22, a first wire member 24, and a second wire member 26. The medical scope 10 is moveable between a substantially straight configuration, as shown in FIG. 1, a first deflected configuration, as shown in FIG. 2, and a second deflected configuration, as shown in FIG. 2. In the illustrated embodiment, the medical scope 10 is a ureteroscope 11 and can be used to accomplish ureteroscopy. However, the medical scopes described herein can be used to perform any suitable treatment.

[0118] The outer elongate member 16 has a lengthwise axis 29, a first end 30, a second end 32, a length 33, a first side 34, a second side 36, and a circumferential wall 38 that extends between the first end 30 and the second end 32. The first end 30 is partially disposed within the handle 20 and is attached to the handle 20. The second end 32 is attached to the distal tip 22. In the embodiment shown, the first end 30 is attached to the manifold 96, as shown in FIG. 22 and as described in more detail herein, and the second end 32 is attached to the retention disk 182, asshown in FIG. 6 and described in more detail herein. The length 33 extends from the first end 30 to the second end 32. In the embodiment shown, the length 33 is about 60cm. However, in alternative embodiments, a length can be less than, or greater than, 60cm to accommodate varying anatomies. The first side 34 opposably faces the second side 36 relative to the lengthwise axis 29.

[0119] As shown in FIGS. 1, 6, 8, 9, and 17 the circumferential wall 38 has an outer surface 40, an inner surface 42, an outer diameter 43, and defines an inner lumen 44, a plurality of indentations 46, a first recess 48, and a second recess 50. In the illustrated embodiment, the outer diameter 43 is equal to about 3.5mm. However, in alternative embodiments, an outer elongate member can have an outside diameter that is greater than, or less than, 3.5mm. The inner lumen 44 extends from the first end 30 to the second end 32 and is in fluid communication with the central passageway 126 of the manifold 96, the irrigation port 124 of the manifold 96, the tubular member 100 of the handle 20, and the irrigation port 98 of the handle 20, as described in more detail herein.

[0120] Each indentation of the plurality of indentation 46 extends radially inward and toward the lengthwise axis 29 and provides a mechanism for maintaining the position, and guiding the movement, of a wire member during use. In the illustrated embodiment, each indentation of the plurality of indentations 46 extends radially inward and contacts the inner elongate member 18. However, in alternative embodiments, an indentation can be free of contact with an inner elongate member. In the embodiment shown, each indentation of the plurality of indentations 46 extends radially inward about 12% of the inside diameter 77 of the outer elongate member 16. However, alternative embodiments can include an indentation, or a plurality of indentations in which each indentation of the plurality of indentations, extends radially inward between about 1% and about 25%, between about 5% and about 20%, or between about 10% and about 15% of the inside diameter of an outer elongate member. Each indentation of the plurality of indentations 46 defines a channel 52 in the outer surface 40, which extends parallel to the lengthwise axis 29, within which one of the first wire member 24 or second wire member 26 is disposed and guided from the handle 20 to the distal tip 22, as shown in FIG. 17. The channel 52 is configured to maintain the position of and guide the movement of a wire member 24, 26.

[0121] In the illustrated embodiment, and as shown in FIG. 17, a first indentation 54 of the plurality of indentations 46 is positioned on the first side 34 of the outer elongate member 16 anda second indentation 56 of the plurality of indentations 46 is positioned on the second side 36 of the outer elongate member 16. The first indentation 54 is disposed on a first axis 55 disposed orthogonally to the lengthwise axis 29 of the outer elongate member 16. The second indentation 56 is disposed on a second axis 57 disposed orthogonally to the lengthwise axis 29 of the outer elongate member 16 and is different than the first axis 55. This structural arrangement results in indentations 46 that are staggered along the length 33 of the outer elongate member 16. Staggering the plurality of indentations 46 maximizes the space in the inner lumen 44 and accommodates a larger inner elongate member 18 relative to medical scopes that do not include indentations and / or that stagger the indentations.

[0122] While a plurality of indentations 46 has been described, an outer elongate member can include any suitable number of indentations and selection of a suitable number of indentations to include on an outer elongate member can be based on various considerations, such as a desired radius of curvature of an outer elongate member and inner elongate member during deflection. Examples of numbers of indentations considered suitable to include in an outer elongate member include one, at least one, two, a plurality, three, four, five, six, more than six, and any other number considered suitable for a particular embodiment. While each indentation of the plurality of indentations 46 has been illustrated as comprising a deformation of the entire thickness of a wall, an indentation can comprise a deformation (e.g., recess) into one surface of a wall (e.g., outer surface) such that an inner surface of the same wall is not deformed.

[0123] The first recess 48 extends from the second end 32 of the outer elongate member 16 toward the first end 30 of the outer elongate member 16 and on the first side 34 of the outer elongate member 16. The second recess 50 extends from the second end 32 of the outer elongate member 16 toward the first end 30 of the outer elongate member 16 and on the second side 36 of the outer elongate member 16. Each of the first and second recesses 48, 50 is in fluid communication with the inner lumen 44 such that during use irrigation fluid can travel through the inner lumen 44, through each of the first and second recesses 48,50, and away from the lengthwise axis 29 of the outer elongate member 16 into an environment exterior to the medical scope 10, as shown in FIG. 9. In the embodiment shown, irrigation fluid also travels through the inner lumen 44, through each of the first and second recesses 48,50, and away from the lengthwise axis 181 of the distal tip 22 into an environment exterior to the medical scope 10 (e.g., inner lumen 44).

[0124] In the illustrated embodiment, the outer elongate member 16 includes a tubular shaft 58 and a jacket 60, as shown in FIG. 8. As shown in FIGS. 1 and 10 through 16, the tubular shaft 58 has a lengthwise axis 59, a first end 62, a second end 64, a length 63, and a circumferential wall 66 that defines an inner lumen 67 and plurality of slits 68 that are longitudinally spaced along the tubular shaft 58. Each slit of the plurality of slits 68 extends through the circumferential wall 66, provides access to the inner lumen 67, and is axially and circumferentially spaced from an adjacent slit. The pattern of the plurality of slits 68 varies along the length 63 of the tubular shaft 58 resulting in the tubular shaft 58 having a variable stiffness along its length.

[0125] In the illustrated embodiment, and as shown in FIGS. 10 through 16, the tubular shaft 58 has a first portion 232, a second portion 234, a third portion 236, and a fourth portion 238. The plurality of slits 68 includes a first plurality of slits 240, a second plurality of slits 242, and a third plurality of slits 244. The first portion 232 of the tubular shaft 58 extends from the first end 62 toward the second end 64 is free of slits. The second portion 234 of the tubular shaft 58 extends from the first portion 232 to the third portion 236 and includes the first plurality of slits 240. The third portion 236 of the tubular shaft 58 extends from the second portion 234 to the fourth portion 238 and includes the second plurality of slits 242. The fourth portion 238 of the tubular shaft 58 extends from the third portion 236 to the second end 64 and includes the third plurality of slits 244.

[0126] In the embodiment shown, each slit of the plurality of slits 68 is laser cut and the tubular shaft 58 has a first stiffness along the first portion 232, a second stiffness along the second portion 234, a third stiffness along the third portion 236, and a fourth stiffness along the fourth portion 238. The second stiffness is different than the first stiffness, the third stiffness is different than the second stiffness, and the fourth stiffness is different than the third stiffness. In the illustrated embodiment, the first stiffness is greater than the second stiffness, the third stiffness, and the fourth stiffness. The second stiffness is greater than the third stiffness and the fourth stiffness. The third stiffness is greater than the fourth stiffness. This structural arrangement results in the fourth portion 238 being more flexible relative to the first portion 232 and allows the medical scope 10 to achieve the deflected configurations without use of additional vertebrae or linkages. In addition, the inclusion of a tubular shaft that has a variable stiffness along its length provides a mechanism for a medical scope to have sufficient stiffness to access a lower urinary tract and have the flexibility to reach calyces of the kidney. Currently, this is performed with two devises: a rigid cystoscope toaccess the lower urinary tract and a flexible ureteroscope to access the calyces. Performing these parts of the procedure with one device, such as the medical scopes described herein, reduces the number of devices required to complete the procedure and the time required to perform treatment.

[0127] A first portion of a tubular shaft can include any suitable length of a tubular shaft, such as 10% of a length of a tubular shaft. FIGS. 28 through 30 illustrate various stiffness profiles for alternative tubular shafts. FIG. 28 illustrates a tubular shaft 58’ with a stiffness that decreases from a first end 62’ to a second end 64’. FIG. 29 illustrates a tubular shaft 58” that has a constant, first stiffness along a first portion 232” that is about 10% of its length 63” and a second stiffness that decreases linearly along the remainder of the length 63” that extends from the first portion 232” to the second end 64”. FIG. 30 illustrates a tubular shaft 58’” that has a constant, first stiffness along a first portion 232” ’ that is about 50% of its length 63’” and a second stiffness that decreases rapidly along the remainder of the length 63’” that extends from the first portion 232’” to the second end 64’”.

[0128] As shown in FIGS. 10 and 11, each slit within the first plurality of slits 240 partially extends around the circumference of the tubular shaft 58 and has a first end portion 248 and a second end portion 250. Each slit within the first plurality of slits 240 has the same structural arrangement. Except for the slit 246 disposed adjacent to the first portion 232 of the tubular shaft 58, the first end portion 248 and the second end portion 250 of each slit of the first plurality of slits 240 is axially adjacent to two other slits within the first plurality of slits 240. As used herein, the phrase “axially adjacent” means that one feature is adjacent another feature along a length of a structure. A first slit 252 of the first plurality of slits 240 has first end 254 disposed on a first axis 255 that is parallel to the lengthwise axis 59 of the tubular shaft 58. A second slit 256 of the first plurality of slits 240 has a first end 258 disposed on a second axis 257 that is parallel to the lengthwise axis 59 of the tubular shaft 58 and different than, and non-coaxial with, the first axis 255. Alternating slits within the first plurality of slits 240 and along the length 63 of the tubular shaft 58 are disposed in a helical configuration about the lengthwise axis 59 of the tubular shaft 58.

[0129] As shown in FIG. 12, the second plurality of slits 242 includes large slits 260 and small slits 262. Each slit of the second plurality of slits 242 partially extends around the circumferenceof the tubular shaft 58. Each large slit 260 has a first geometry and each small slit 262 has a second geometry that is different than the first geometry. In the illustrated embodiment, each large slit 260 has a first axial width 259 and a first circumferential length 261 and each small slit 262 has a second axial width 263 and a second circumferential length 265. The first axial width 259 is greater than the second axial width 263 and the first circumferential length 261 is greater than the second circumferential length 265. Each large slit 260 is axially adjacent to two other large slits within the second plurality of slits 242 and circumferentially adjacent to one small slit 262. As used herein, the phrase “circumferentially adjacent” means that one feature is adjacent another feature along a circumference of a structure. Alternating large slits 260 within the second plurality of slits 242 and along the length 63 of the tubular shaft 58 are disposed in a helical configuration about the lengthwise axis 59 of the tubular shaft 58.

[0130] As shown in FIG. 13, each slit within the third plurality of slits 244 partially extends around the circumference of the tubular shaft 58 and has a first end portion 268 and a second end portion 270. Each slit within the third plurality of slits 244 has the same structural arrangement. The first end portion 268 and the second end portion 270 of each slit within the third plurality of slits 244 is axially adjacent to two other slits within the third plurality of slits 244. In the illustrated embodiment, the first end portion 268 and second end portion 270 of each slit within the third plurality of slits 244 has a bulbous portion 27 E Each slit in a first set 272 of the third plurality of slits 244 has first end 274 disposed on a first axis 275 that is parallel to the lengthwise axis 59 of the tubular shaft 58. Each slit in a second set 276 of the third plurality of slits 244 has a first end 278 disposed on a second axis 279 that is parallel to the lengthwise axis 59 of the tubular shaft 58 and different than, and non-coaxial with, the first axis 275. The slits within the third plurality of slits 244 alternate the side of the tubular shaft 58 on which they are disposed such that the first set 272 of the third plurality of slits 244 is disposed on a first side 282 of the tubular shaft 58 and the second set 276 of the third plurality of slits 244 is disposed on a second side 285 of the tubular shaft 58. The first side 282 opposably facing the second side 285 relative to the lengthwise axis 29 of the outer elongate member 16.

[0131] As shown in FIGS. 14 through 16, a portion 286 of the tubular shaft 58 disposed between some of the axially adjacent slits in the third plurality of slits 244 is utilized to create an indentation of the plurality of indentations 46. This is accomplished by moving (e.g., crimping) the portion286 of the tubular shaft 58 radially inward (e.g., outer surface and inner surface) and toward the lengthwise axis 59 of the tubular shaft 58. As a result, and as shown in FIG. 18, the portion 286 of the tubular shaft 58 is disposed a first distance 287 from the lengthwise axis 59 of the tubular shaft 58 and a second portion 288 of the tubular shaft 58 that is not moved radially inward is disposed a second distance 289 from the lengthwise axis 59 that is greater than the first distance 287. In the embodiment shown, the plurality of indentations 46 is only disposed on the fourth portion 238 of the tubular shaft 58. However, in alternative embodiments, an indentation, or a plurality of indentations, can be included on any suitable portion of a tubular shaft (e.g., first portion, second portion, third portion, and / or fourth portion) and / or can include only moving (e.g., crimping) a portion of a tubular shaft radially inward (e.g., outer surface and not an inner surface) and toward a lengthwise axis of the tubular shaft.

[0132] The jacket 60 covers the tubular shaft 58, the first wire member 24, the second wire member 26, and each slit of the plurality of slits 68. In the embodiment shown, the jacket 60 completely surrounds the tubular shaft 58, prevents fluid (e.g., irrigation fluid) from passing through the plurality of slits 68 creating a waterproof barrier, and provides a surface that reduces friction along the outer surface 40 when the medical scope 10 traverses a bodily passage (e.g., urinary tract) and the inner surface 42 relative to devices that do not include a jacket. As a result, the medical scope 10 can utilize an interstitial space 84 defined by the outer elongate member 16 and the inner elongate member 18, as described in more detail herein, as a conduit for irrigation fluid without leaking or weeping along the length 33 of the outer elongate member 16. Optionally, a jacket of an outer elongate member can be coated in a hydrophilic solution to aid in advancement into a bodily passage.

[0133] A tubular shaft and a jacket can be formed of any suitable material and selection of a suitable material can be based on various considerations, such as the intended use of a medical scope of which the tubular shaft and jacket are components. Examples of materials considered suitable to form a tubular shaft include metals, such as stainless steel, kink resistant materials, and any other material considered suitable for a particular embodiment. Examples of materials considered suitable to form a jacket include polymers, and any other material considered suitable for a particular embodiment.

[0134] The inner elongate member 18 is disposed within, and partially extends through, the handle 20 (e.g., the manifold 96) and is disposed within, and partially extends through, the inner lumen 44 of the outer elongate member 16. The inner elongate member 18 has a central axis 73, a first end 74, a second end 76, and defines an inner elongate member lumen 78 (e.g., working channel) that has an inside diameter 79. As shown in FIG. 22, the first end 74 is attached to the handle 20. In the embodiment shown, the first end 74 is attached to the second portion 116 of the manifold 96 such that the inner elongate member lumen 78 is in fluid communication with the first and second ports 130, 132 of the second portion 116 of the manifold 96. As shown in FIG. 17, the second end 76 is attached to the distal tip 22. In the embodiment shown, the second end 76 is attached to the chassis 184. During use, suction can be applied to the inner elongate member lumen 78 (e.g., concurrent with irrigation) to remove small stone particulate, such as particulate created during laser lithotripsy, and other debris while the medical scope 10 is in the substantially straight configuration or a deflected configuration. The inside diameter 79 of the inner elongate member 18 is about 1.8mm and is greater than Vi of the inner lumen inside diameter 77. However, in alternative embodiments, an inner elongate member can have any suitable inside diameter such as those that are greater than, or less than, 1.8mm, those that are about, less than, greater than, or equal to % of the inner lumen inside diameter, those that are about, less than, greater than, or equal to the inner lumen inside diameter, and / or any other inside diameter considered suitable for a particular embodiment. Selection of an inside diameter of an inner elongate member can be based on various considerations, including the size of particulate desired to be removed from a bodily passage. As shown in FIG. 18, the inner elongate member lumen 78 has a first cross-sectional area taken along a cross-section of the medical scope 10 between the first end 30 of the outer elongate member 16 and the second end 32 of the outer elongate member 16. The interstitial space 84 has a second cross-sectional area taken along the same cross-section. The first cross-sectional area is greater than the second cross-sectional area.

[0135] As shown in FIGS. 17 and 18. the central axis 73 is non-linear and the inner elongate member 18 weaves through the inner lumen 44. Weaving an inner elongate member through an inner lumen allows for use of a larger inner elongate member relative to devices that include two indentations on an axis that is perpendicular to a central axis of an inner elongate member. The central axis 73 and the inner elongate member 18 along a first axial portion 80 of the inner elongate member 18 that is not disposed circumferentially adjacent to an indentation of the plurality ofindentations 46 are disposed on a first axis 81 and a first distance 83 from the lengthwise axis 29 of the outer elongate member 16. The central axis 73 and the inner elongate member 18 along a second axial portion 82 of the inner elongate member 18 that is disposed circumferentially adjacent to an indentation of the plurality of indentations 46 are disposed on a second axis 85 and a second distance 87 from the lengthwise axis 29 of the outer elongate member 16. The second axis 85 is different than the first axis 81. Each of the first axis 81 and the second axis 85 is disposed parallel relative to the lengthwise axis 29 of the outer elongate member 16. Alternative embodiments, however, can include a first axis and / or a second axis that is disposed at an angle relative to a lengthwise axis of an outer elongate member. The first distance 83 is less than the second distance 87.

[0136] An inner elongate member can be formed of any suitable material and selection of a suitable material to form an inner elongate member can be based on various considerations, such as the desired inside diameter of an inner elongate member and / or the desired stiffness of an inner elongate member. Examples of materials considered suitable to form an inner elongate member include braided materials, polymers, materials lined with polytetrafluoroethylene, kink resistant materials, and any other material considered suitable for a particular embodiment. In the illustrated embodiment, the inner elongate member is formed of a braided polymer tubing lined with polytetrafluoroethylene. In the embodiment shown, the outer elongate member 16 is formed of a first material and the inner elongate member 18 is formed of a second material that is different than the first material.

[0137] An interstitial space 84 is cooperatively defined by the outer elongate member 16 and the inner elongate member 18 and between the outer elongate member 16 and the inner elongate member 18. The interstitial space 84 extends from the handle 20 (e.g., manifold 96) to the retention disk 182 and the first and second openings 206, 208 cooperatively defined by the outer elongate member 16 and the distal tip 22, as described in more detail herein. In the illustrated embodiment, the first and second openings 206, 208 are irrigation passageways. The interstitial space 84 provides a pathway for irrigation fluid to travel from the handle 20 to the distal tip 22. Utilizing an interstitial space for irrigation provides a mechanism for accomplishing independent operation of suction and irrigation. As a result, dust and small particulate can be removed with suction while continuously, and concurrently, applying irrigation to a target site.

[0138] The handle 20 is disposed on the first end 30 of the outer elongate member 16. The handle 20 defines a chamber 90 and has a lengthwise axis 89, a first end 92, a second end 94, a manifold 96, an irrigation port 98. a tubular member 100, a wire port 102, a baffle 104, an actuator 106. and a circuit board 108. Each of the manifold 96, the tubular member 100, the baffle 104, the actuator 106, and the circuit board 108 is housed within the chamber 90 defined by the handle 20. In the illustrated embodiment, the handle 20 is designed to be held and operated horizontally, which increases pushability of the medical scope 10, decreases the overall length 33 of the outer elongate member 16, and increases comfort during use relative to devices that are operated vertically.

[0139] The manifold 96 is partially disposed within the chamber 90 and distal to the actuator 106. In the illustrated embodiment, the manifold 96 is disposed between the second end 94 of the handle 20 and the actuator 106 and, as shown in FIGS. 22 through 25, includes a first portion 114, a second portion 116, a cap 118, a bung 120, a seal 122, and an irrigation port 124. The first portion 114 defines a central passageway 126 and a port passageway 128. The central passageway 126 is in fluid communication with the inner lumen 44 of the outer elongate member 16. Each of the bung 120 and the seal 122 is disposed within the central passageway 126. The port passageway 128 is in fluid communication with the central passageway 126 and extends from the central passageway 126 and to the second portion 116 of the manifold 96.

[0140] The second portion 116 is attached to the first portion 114 and defines a first port 130, a second port 132, a first passageway 134 through the first port 130, and a second passageway 136 through the second port 132. The first port 130 and the second port 132 are in fluid communication with the inner elongate member lumen 78. The first and second passageways 134, 136 meet at a junction 138 such that a secondary device (e.g., laser fiber) can be passed through the first passageway 134 and into the inner elongate member lumen 78 while suction is concurrently applied via the second port 132 to the inner elongate member lumen 78. In the embodiment shown, the inner elongate member 18 is attached to the second portion 116 at the junction 138 such that the first and second passageways 134, 136 are in fluid communication with the inner elongate member lumen 78. This enables the inner elongate member lumen 78 to both hold a laser fiber while also allowing suction to remove particulate creating during lithotripsy.

[0141] The cap 118 is attached to the first portion 1 14 and compresses the bung 120 and seal122 between the first portion 114 and the cap 118, preventing leakage around the first and second wire members 24, 26. Attachment of the cap 118 to the first portion 114 can be accomplished using any suitable method or technique, such as using threaded fasteners. The bung 120 is disposed between the first portion 114 and the cap 118. As shown in FIG. 23, the bung 120 has a first end 140, a second end 142, and defines a slit 144, a first passageway 146, and a second passageway 148. Each of the slit 144, the first passageway 146, and the second passageway 148 extends from the first end 140 to the second end 142. The slit 144 receives the second wire harness 176 that is attached to the circuit board 108 and extends from the circuit board 108 to the devices housed on the distal tip 22 (e.g., imaging device 188, pressure sensor 190, light source 192, temperature sensor 194). The first passageway 146 receives the first wire member 24 and allows the first wire member 24 to move within the first passageway 146. The second passageway 148 receives the second wire member 26 and allows the second wire member 26 to move within the second passageway 148.

[0142] The seal 122 is disposed between the bung 120 and the cap 118 and defines a passageway123 through which the second wire harness 176, the first wire member 24, and the second wire member 26 are disposed. The seal 122 provides a dynamic seal around the second wire harness 176, the first wire member 24, and the second wire member 26. The irrigation port 124 is in fluid communication with the central passageway 126 and, as a result of the attachment of the outer elongate member 16 to the manifold 96, is in fluid communication with the inner lumen 44 and interstitial space 84.

[0143] The inclusion of the manifold 96 reduces the space required relative to devices that have separate laser fiber channels and allows the medical scope 10 to include a larger inner elongate member lumen 78. While the manifold 96 has been described as positioned between the actuator 106 and the second end 94 of the handle 20, alternative embodiments can include a manifold, or a portion of a manifold, at other locations on a handle. For example, a manifold, or a second portion of a manifold (e.g., first and second ports), can be positioned adjacent to an actuator, between an actuator and a first end of a handle, or at a first end of a handle. An embodiment in which the second port 132’ is positioned on the first end 92’ of the handle 20’ is shown in FIGS. 31 and 32. A structural arrangement in which the manifold is disposed at, or near, the first end of the handlemay provide ergonomic advantages in that it may allow greater flexibility in the way the handle is held and move various components behind a user’ s hand during use. This structural arrangement could also lower the handle’s center of gravity, possibly reducing fatigue due to handling and rotating the handle, and provide a straighter pathway for the suction tubing, which could decrease the probability of blockage.

[0144] In the embodiment shown, the irrigation port 98 of the handle 20 is disposed on the first end 92 of the handle 20 and adjacent to the wire port 102. The tubular member 100 has a first end 150 attached to the irrigation port 98, extends through the handle 20, and has a second end 152 attached to the irrigation port 124 of the manifold 96 such that irrigation fluid supplied to the irrigation port 98 of the handle 20 can be supplied to the interstitial space 84 between the outer elongate member 16 and the inner elongate member 18.

[0145] The wire port 102 is disposed on the first end 92 of the handle 20 and provides access to the chamber 90. The wire port 102 is a conduit through which the first wire harness 174 extends and is electrically connected to the circuit board 108, the imaging device 188, the pressure sensor 190, the light source 192, and the temperature sensor 194.

[0146] The baffle 104 is disposed between the manifold 96 and the actuator 106 and includes a support 160, a first roller 162, and a second roller 164. The support 160 is attached to the handle 20. The first roller 162 is rotatably attached to the support 160 and contacts the first wire member 24. The second roller 164 is rotatably attached to the support 160 contacts the second wire member 26. The first and second rollers 162, 164 maintain tension on the first and second wire members 24, 26, provide structure for guiding the first and second wire members 24, 26, respectively, into the manifold 96, and prevent contact with other components within the chamber 90 defined by the handle 20.

[0147] As shown in FIG. 3, the actuator 106 is moveable between a first position 107, a second position 107’, and a third position 107”. The medical scope 10 is in the substantially straight configuration when the actuator 106 is in the first position 107. The medical scope 10 is in a first deflected configuration when the actuator 106 is in the second position 107’. The medical scope 10 is in a second deflected configuration when the actuator 106 is in the third position 107”. In the embodiment shown, and as shown in FIG. 2, the outer elongate member 16 and the innerelongate member 18 deflect about 270 degrees in the first and second deflected configurations such that the outer elongate member 18 has a radius of curvature of about 1cm. However, in alternative embodiments, an outer elongate member and an inner elongate member can deflect any suitable amount, such as angles less than, or greater than, 270 degrees and / or radii of curvature less than, or greater than, 1 cm, such as 15mm. While the medical scope 10 has been illustrated as being deflectable in two directions in a single plane, a medical scope can be configured to be deflectable in a single direction, or in more than two directions and / or such that it can be deflected in multiple planes.

[0148] In the illustrated embodiment, the actuator 106 is disposed between the baffle 104 and the circuit board 108 and includes a steering drum 166 and a lever 168. The steering drum 166 is rotatably attached to the handle 20 and, as shown in FIG. 27, defines a first circumferential recess 170 and a second circumferential recess 172. In the embodiment shown, the steering drum 166 rotates about an axis 167 that is orthogonal to a plane that includes the lengthwise axis 89 of the handle 20. The first circumferential recess 170 receives the first wire member 24 and the second circumferential recess 172 receives the second wire member 26. In the embodiment shown, the first wire member 24 is partially disposed within a first alignment tube 171 that is disposed within the first circumferential recess 170 and the second wire member 26 is partially disposed within a second alignment tube 173 that is disposed within the second circumferential recess 172. The inclusion of alignment tubes 171 , 173 maintains the position of the first and second wire members 24, 26 on the steering drum 166 since the amount of retraction is not 1:1 between the first and second wire members 24, 26 when one is being pulled to accomplish deflection.

[0149] The lever 168 is attached to the steering drum 166 and is moveable between a first position 107. a second position 107’. and a third position 107”, as shown in FIG. 3. The lever 168 is in a first position when the actuator 106 is in the first position. The lever 168 is in a second position when the actuator 106 is in the second position. The lever 168 is in a third position when the actuator 106 is in the third position. Movement of the lever 168 from the first position to the second position results in movement of the steering drum 166 and movement of the first and second wire members 24, 26 such that medical scope 10 moves from its substantially straight configuration to its first deflected configuration. Movement of the lever 168 from the first position to the third position results in movement of the steering drum 166 and movement of the first andsecond wire members 24, 26 such that medical scope 10 moves from its substantially straight configuration to its second deflected configuration. Movement of the lever 168 from the second position or the third position to the first position results in movement of the steering drum 166 and movement of the first and second wire members 24, 26 such that medical scope 10 moves from a deflected configuration to its substantially straight configuration. In the illustrated embodiment, the lever 168 is positioned inboard of the handle 20 profile to provide improved handling and comfort. While a mechanical actuator has been described, any suitable type of actuator can be included on a medical scope, such as electromechanical actuators, hydraulic actuators, pneumatic actuators, rotary actuators, electric rotary actuators, piezoelectric actuators, electromagnetic actuators, linear actuators, and any other actuator considered suitable for a particular embodiment.

[0150] The circuit board 108 is disposed between the actuator 106 and the first end 92 of the handle 20. The circuit board 108 is connected (e.g., electrically, wirelessly) to an ancillary device (e.g., computer) using a first wire harness 174 that extends from the circuit board 108, through the wire port 102, and to the ancillary device. The circuit board 108 is connected (e.g., electronically, wirelessly) to each of the imaging device 188, the pressure sensor 190, the light source 192, and the temperature sensor 194 using a second wire harness 176 that extends from the circuit board 108, through the manifold 96, within the interstitial space 84, and to the distal tip 22. Each of the first and second wire harnesses 174, 176 includes the wires, optical fibers, and / or other connectors utilized to power and connect a component included on a distal tip to the circuit board 108 and / or an ancillary device.

[0151] The distal tip 22 is attached to the outer elongate member 16 (e.g., second end 32) and the inner elongate member 18 (e.g., second end 76). In the embodiment shown, the distal tip 22 has a lengthwise axis 181 and includes a retention disk 182, a chassis 184, a sleeve 186. an imaging device 188, a pressure sensor 190, a light source 192, and a temperature sensor 194. The distal tip 22 houses the components of the medical scope 10 that enable an image of a bodily passage to be transmitted outside of the bodily passage. A distal tip can be attached to an outer elongate member and an inner elongate member using any suitable technique or method of attachment and selection of suitable technique or method of attachment can be based on various considerations, such as the treatment intended to be performed using a medical scope of which the distal tip is a component. Examples of techniques and methods of attachment considered suitable between a distal tip andan outer elongate member and an inner elongate member include using adhesives, soldering, welding, laser welding, lamination, or any other technique or method considered suitable for a particular embodiment. In the embodiment shown, the outer elongate member 16 is attached to the retention disk 182 via laser welding and the inner elongate member 18 is attached to the chassis 184 using adhesives.

[0152] The retention disk 182 is disposed between the outer elongate member 16 and the chassis 184. The retention disk 182 has a first side 196, a second side 198, and defines a central passageway 200, a first wire member passageway 202, and a second wire member passageway 204. Each of the central passageway 200, the first wire member passageway 202, and the second wire member passageway 204 extends from the first side 196 to the second side 198. The central passageway 200 receives the inner elongate member 18 and the second wire harness 176. The first wire member passageway 202 receives the first wire member 24. The second wire member passageway 204 receives the second wire member 26. In the illustrated embodiment, the retention disk 182 is the distal end of the interstitial space 84. The first side 196 of the retention disk 182 acts as a mechanical stop to advancement of irrigation fluid through the interstitial space 84 such that it is forced out of first and second openings 206, 208 during use.

[0153] The distal tip 22 and the outer elongate member 16 cooperatively define a first opening 206 and a second opening 208. In the illustrated embodiment, the retention disk 182 and the outer elongate member 16 cooperatively define the first opening 206 and the second opening 208. Each of the first opening 206 and the second opening 208 has a height 203 and a width 205 that is less than the height 203. Each of the first opening 206 and the second opening 208 is in fluid communication with the interstitial space 84 defined between the outer elongate member 16 and the inner elongate member 18 and acts as an outlet for irrigation fluid during use. For example, during use, as shown in FIG. 9, irrigation fluid 201 travels from a source connected to the handle 20 (e.g., irrigation port 98), through the tubular member 100, through the manifold 96, through the interstitial space 84, through the first and second openings 206, 208, away from the lengthwise axis 29 of the outer elongate member 16, and into a bodily passage (e.g., renal cavity). In the embodiment shown, irrigation fluid 201 also travels from a source connected to the handle 20 (e.g., irrigation port 98), through the tubular member 100, through the manifold 96, through the interstitial space 84, through the first and second openings 206, 208, away from the lengthwiseaxis 181 of the distal tip 22, and into a bodily passage (e.g., renal cavity). Once in the bodily passage, the fluid 201 passed from the first and second openings 206, 208 (e.g., distal tip 22) is directed toward the second end 14 of the medical scope 10, into the inner elongate member lumen 78, and towards the handle 20 when suction is being applied (e.g., to the inner elongate member lumen 78). In the embodiment shown, when suction is being applied, fluid initially travels substantially parallel to the lengthwise axis 29 of the outer elongate member 16 and the lengthwise axis 181 of the distal tip 22 within the distal tip 22 and then along the central axis 73 of the inner elongate member 18. The first and second openings 206, 208 are disposed on an axis 207 that is disposed orthogonally to the lengthwise axis 29 of the outer elongate member 16. As a result, fluid is passed through the first and second openings 206, 208 orthogonally relative to the lengthwise axis 29 of the outer elongate member 16 and the lengthwise axis 181 of the distal tip 22. However, in alternative embodiments, first and second openings can be defined at any suitable location on a medical scope, such as on a distal tip, on a second end of a distal tip, and / or be defined on axes that are different from one another, on axes that are disposed at any suitable angle relative to a lengthwise axis of an outer elongate member and / or a lengthwise axis of a distal tip, and / or irrigation fluid can pass through a dedicated tubular member disposed within an interstitial space. For example, any opening or passageway defined by an outer elongate member and / or distal tip can be utilized to provide irrigation fluid to a bodily passage. Examples of outer elongate members and / or distal tips considered suitable to include in a medical scope, such as medical scope 10, include any outer elongate member described herein, any distal tip described herein, outer elongate member 316 shown in FIGS. 33 through 34, distal tip 322 shown in FIGS. 33 through 34, outer elongate member 516 shown in FIGS. 42 through 44, distal tip 522 shown in FIGS. 42 through 45, outer elongate member 616 shown in FIGS. 46 through 51, distal tip 622 shown in FIGS 46 through 50 and FIGS. 63 through 64, distal tip 1002 shown in FIGS. 68 through 69, distal tip 1052 shown in FIG. 70, distal tip 1102 shown in FIGS. 71 through 73, distal tip 1152 shown in FIG. 74, distal tip 1172 shown in FIG. 75, distal tip 1202 shown in FIGS. 76 through 77, distal tip 1252 shown in FIG. 78, distal tip 1302 shown in FIGS. 79 through 80, distal tip 1352 shown in FIGS. 81 through 82, distal tip 1402 shown in FIGS. 83 through 84, distal tip 1452 shown in FIGS. 85 through 86, distal tip 1502 shown in FIGS. 87 through 88, elongate member 1616 shown in FIGS 89 through 105, and / or distal tip 1622 shown in FIGS. 89 through 105.

[0154] The chassis 184 is disposed between the retention disk 182 and the sleeve 186. The chassis 184 defines an imaging device recess 212, a pressure sensor recess 214, a light source recess 216, and a temperature sensor recess 218 and houses the imaging device 188, the pressure sensor 190, the light source 192, and the temperature sensor 194 between the chassis 184 and the sleeve 186. Each of the imaging device recess 212, the light source recess 216, and a temperature sensor recess 218 extends to the second end 14 of the medical scope 10 and the pressure sensor recess 214 extends to a side of the chassis 184.

[0155] The sleeve 186 is disposed on second end 14 end of the medical scope 10, has a first end 219, a second end 221, an angled portion 223, and an opening 225 disposed on a side of the sleeve 186 that receives the pressure sensor 190. The sleeve 186 covers the chassis 184 and the components housed by the chassis 184 and has an outside diameter 227 equal to about 3.5mm. However, in alternative embodiments, a sleeve can have an outside diameter that is less than, or greater than, 3.5mm. The second end 221 and angled portion 223 have rounded edges to avoid trauma to tissue surrounding a bodily passageway. The angled portion 223 extends from the second end 221 towards the first end 219 and aids in the removal of stone fragments and dust created during lithotripsy.

[0156] The imaging device 188 and the light source 192 enable visualization of a bodily passage during use (e.g., urinary tract during ureteroscopy). The pressure sensor 190 and temperature sensor 194 enable real-time pressure and temperature monitoring inside a bodily passage during use (e.g., ureteroscopy). An imaging device can include any suitable device capable of obtaining and transmitting images, such as a camera (e.g., camera having dimensions of 0.65mm x 0.65mm), optical fibers, and any other imaging device considered suitable for a particular embodiment. A light source can include any suitable device capable of producing light, such as LEDs, optical fibers, and any other light source considered suitable for a particular embodiment. A temperature sensor can include any suitable device capable of measuring temperature, such as a thermistor, and any other temperature sensor considered suitable for a particular embodiment. A pressure sensor can include any suitable device capable of measuring pressure.

[0157] The inclusion of a distal tip, such as those described herein, on a medical scope contributes to a tighter bend radius during use relative to devices that do not include such distaltips, which improves performance of the medical scope during deflection, and allows the medical scope to reach and access tortuous anatomy. For example, the inclusion of a distal tip, such as those described herein, allows a medical scope to access many areas of the urinary tract during ureteroscopy, including those located in the lower pole of the kidneys, a location that is generally recognized as difficult to reach using most currently available ureteroscopes.

[0158] The first wire member 24 is attached to the handle 20 (e.g., actuator 106) and the distal tip 22 and has a first end 220 and a second end 222. In the embodiment shown, the first end 220 of the first wire member 24 is attached to the actuator 106 (e.g., steering drum 166) and the second end 222 of the first wire member 24 is attached to the retention disk 182 using a ferrule 224. The first wire member 24 extends from the first end 220, within the first circumferential recess 170 of the steering drum 166, within the first alignment tube 171, through the baffle 104 and contacts the first roller 162, through the central passageway 126 of the manifold 96, through a portion of the inner lumen 44 of the outer elongate member 16 and within the interstitial space 84, radially outward of the first indentation 54 of the plurality of indentations 46 such that the first wire member 24 is disposed between the tubular shaft 58 and the jacket 60, through a second portion the inner lumen 44 within the interstitial space 84, and to the retention disk 182. A first portion of the first wire member 24 extends partially through the inner lumen 44 and a second portion of the first wire member 24 extends radially outward of the first indentation 54, for example along a channel 52 defined by the first indentation 54. The first portion of the first wire member 24 is disposed between the outer elongate member 16 and the inner elongate member 18.

[0159] The second wire member 26 is attached to the handle 20 and the distal tip 22 and has a first end 226 and a second end 228. In the embodiment shown, the first end 226 of the second wire member 26 is attached to the actuator 106 (e.g.. steering drum 166) and the second end 228 of the second wire member 26 is attached to the retention disk 182 using a ferrule 230. The second wire member 26 extends from the first end 226, within the second circumferential recess 172 of the steering drum 166, within the second alignment tube 173, through the baffle 104 and contacts the second roller 164, through the central passageway 126 of the manifold 96, through a portion of the inner lumen 44 of the outer elongate member 16 and within the interstitial space 84, radially outward of the second indentation 56 of the plurality of indentations 46 such that the second wire member 26 is disposed between the tubular shaft 58 and the jacket 60, through a second portionthe inner lumen 44 within the interstitial space 84, and to the retention disk 182. A first portion of the second wire member 26 extends partially through the inner lumen 44 and a second portion of the second wire member 26 extends radially outward of the second indentation 56, for example along a channel 52 defined by the second indentation 56. The first portion of the second wire member 26 is disposed between the outer elongate member 16 and the inner elongate member 18.

[0160] While two wire members 24, 26 have been illustrated, a medical scope can include any suitable number of wire members, such as one, at least one. two, a plurality, more than two, or any other number considered suitable for a particular embodiment. A wire member can comprise any element having the features described herein. For example, a wire member can comprise a length of a single piece of material (e.g., non-metal, metal), a length of braided material, or any other material, or combination of materials, considered suitable for a particular embodiment.

[0161] During use, the medical scope 10 is advanced into a bodily passage and the handle 20 assembly is held by a user to control the functionality of the various components. A laser fiber is passed through the first port 130 of the second portion 116 of the manifold 96, through the inner elongate member lumen 78, and to the second end 14 of the medical scope 10 such that treatment can be performed. In addition, suction can be applied to the second port 132, such that suction is applied through the inner elongate member lumen 78 and at the second end 14 of the medical scope 10. Moreover, irrigation can be applied to the irrigation port 98 such that irrigation fluid travels through the tubular member 100, the manifold 96, through the interstitial space 84, and to the second end 14 of the medical scope 10. Optionally, treatment using the laser fiber, suction, and irrigation can all be accomplished concurrently, or separately. Use of a leak-proof seal (e.g., Touhy Borst adapter) when passing a laser fiber through the first port 130 reduces or prevents a loss of suction within the inner elongate member lumen 78 during use.

[0162] FIGS. 33 through 41 illustrate a second example medical scope 310. The medical scope 310 has a first end 312, a second end 314, an outer elongate member 316, an inner elongate member 318, a handle 320, a distal tip 322, a first wire member 324, and a second wire member 326. The medical scope 310 is moveable between a substantially straight configuration, as shown in FIG. 34, a first deflected configuration, and a second deflected configuration.

[0163] In the embodiment shown, the handle 320 defines a chamber 332 and has a first end 334, a second end 336, a manifold 338, an irrigation port 340, a tubular member 342, a wire port 344, a plurality of guide pins 346, a plurality of rolling pins 348. a plurality of brackets 350, an actuator 352, and a circuit board 354. Each of the manifold 338, the tubular member 342, the plurality of guide pins 346, the plurality of rolling pins 348, the plurality of brackets 350, the actuator 352, and the circuit board 354 is housed within the chamber 332 defined by the handle 320.

[0164] The plurality of guide pins 346 are disposed between the actuator 352 and the second end 336 of the handle 320. In the illustrated embodiment, the plurality of guide pins 346 includes a first guide pin 360 and a second guide pin 362 opposably positioned from the first guide pin 360 relative to the lengthwise axis 321 of the handle 320. The first guide pin 360 contacts the first wire member 324 and the second guide pin 362 contacts the second wire member 326. The first and second guide pins 360, 362 maintain tension on the first and second wire members 324, 326, provide structure for guiding the first and second wire members 324, 326, respectively, into the manifold 338 and the plurality of rolling pins 348, and prevent contact with other components within the chamber 332 defined by the handle 320.

[0165] The plurality of rolling pins 348 are disposed between the circuit board 354 and the second end 336 of the handle 320. In the illustrated embodiment, the plurality of rolling pins 348 include a first rolling pin 364 and a second rolling pin 366 opposably positioned from the first rolling pin 364 relative to the lengthwise axis 321 of the handle 320. Each rolling pin of the plurality of rolling pins 348 is rotatably attached to the handle 320. The first rolling pin 364 contacts the first wire member 324 and the second rolling pin 366 contacts the second wire member 326. The first and second rolling pins 364, 366 maintain tension on the first and second wire members 324, 326, provide structure for guiding the first and second wire members 324, 326, respectively, onto the actuator 352 and the plurality of guide pins 346, and prevent contact with other components within the chamber 332 defined by the handle 320.

[0166] The plurality of brackets 350 include a first bracket 368 and a second bracket 370 opposably positioned from the first bracket 368 relative to the lengthwise axis 321 of the handle 320. The first bracket 368 is disposed between the first guide pin 360 and the first rolling pin 364. The second bracket 370 is disposed between the second guide pin 362 and the second rolling pin366. Each bracket of the plurality of brackets 350 is attached to the handle 320. During use, if a wire member 324, 326 experiences slack, the plurality of brackets 350 provide structure for preventing the wire members 324, 326 from freeing from a respective rolling pin of the plurality of rolling pins 348 and preventing contact between the wire members 324, 326 and other components within the chamber 332 defined by the handle 320.

[0167] In the illustrated embodiment, the actuator 352 is an electromechanical actuator 353, is disposed between the manifold 338 and the circuit board 354, and includes a steering drum 374, a roller switch 376, and a motor 378. The actuator 352 is moveable between a neutral position, a first position, and a second position. The medical scope 310 is in the substantially straight configuration when the actuator 352 is in the neutral position. The medical scope 310 is in a deflected configuration when the actuator 352 is in the first position or second position. The steering drum 374 is rotatably attached to the handle 320. In the embodiment shown, the steering drum 374 rotates about an axis 375 that extends through the first and second ends 334, 336 of the handle 320. The steering drum 374 rotates about an axis 375 that is parallel to a plane that includes the lengthwise axis 319 of the handle 320.

[0168] The roller switch 376 is electrically connected to the motor 378 and is moveable between a neutral position, a first position, and a second position. The roller switch 376 is in a neutral position when the actuator 352 is in the neutral position. The roller switch 376 is in a first position when the actuator 352 is in the first position. The roller switch 376 is in a second position when the actuator 352 is in the second position. Movement of the roller switch 376 from the neutral position to the first position or the second position results in movement of the steering drum 374 and movement of the first and second wire members 324, 326 such that medical scope 310 moves from its substantially straight configuration to a deflected configuration. Movement of the roller switch 376 from the first position or the second position to the neutral position results in movement of the steering drum 374 and movement of the first and second wire members 324, 326 such that medical scope 310 moves from a deflected configuration to its substantially straight configuration.

[0169] The motor 378 is disposed between the steering drum 374 and the first end 334 of the handle 320. The motor 378 is electrically connected to the roller switch 376 and the circuit board 354 and attached to the steering drum 374 to accomplish movement of the medical scope 310between its substantially straight configuration and deflected configurations. Movement of the roller switch 376 from the neutral position to the first position results in movement of the motor 378 in a first direction and movement of the first and second wire members 324, 326 such that medical scope 310 moves from its substantially straight configuration to a deflected configuration. Movement of the roller switch 376 from the neutral position to the second position results in movement of the motor 378 in a second direction and movement of the first and second wire members 324, 326 such that medical scope 310 moves from its substantially straight configuration to a deflected configuration. Movement of the roller switch 376 from the first position or the second position to the neutral position results in movement of the motor 378 and movement of the first and second wire members 324, 326 such that medical scope 310 moves from a deflected configuration to its substantially straight configuration.

[0170] The distal tip 322 is attached to the second end 390 of the outer elongate member 316 and the second end 377 of the inner elongate member 318. In the embodiment shown, the distal tip 322 includes a frame 392, a chassis 394, a sleeve 396, an imaging device 398, a pressure sensor 400, a light sources 402, and a temperature sensor 404. In the embodiment shown, the outer elongate member 316 is attached to the frame 392 (e.g., via laser welding, using adhesive), the inner elongate member 318 is attached to the chassis 394 (e.g., using adhesive), the frame 392 is attached to the chassis 394 (e.g., using adhesive), the frame 392 is attached to the sleeve 396 (e.g., vis laser welding), and the chassis 394 is attached to the sleeve 396 (e.g., press fit, using adhesives).

[0171] The frame 392 is disposed between the outer elongate member 316 and the chassis 394. The frame 392 has a first side 406, a second side 408, and defines a central passageway 410, a first recess 412, and a second recess 414. The first and second recesses 412, 414 are the same, just positioned on opposite sides of the frame 392. The central passageway 410 extends from the first side 406 to the second side 408 and receives the inner elongate member 318 and the second wire harness 416. The distal tip 322 and the outer elongate member 316 cooperatively define a first opening 418 and a second opening 420. In the illustrated embodiment, the frame 392 and the outer elongate member 316 cooperatively define the first opening 418 and the second opening 420. The first and second openings 418, 420 are the same, just positioned on opposite sides of the medical scope 310. The interstitial space 422 extends from the handle 320 (e.g., manifold 338) to the frame 392. In the illustrated embodiment, the frame 392 is the distal end of the interstitial space 422. Thefirst side 406 of the frame 392 acts as a mechanical stop to advancement of irrigation fluid through the interstitial space 422 such that it is forced out of first and second openings 418, 420 during use. Each of the first opening 418 and the second opening 420 is in fluid communication with the interstitial space 422 defined between the outer elongate member 316 and the inner elongate member 318 and acts as an outlet for irrigation fluid during use. For example, during use, irrigation fluid travels from a source connected to the handle 320. through the handle 320, through the interstitial space 422 between the outer elongate member 316 and the inner elongate member 318, through the first and second openings 418, 420, away from the lengthwise axis 329 of the outer elongate member 316, away from the lengthwise axis 481 of the distal tip 322, and into a bodily passage. In the illustrated embodiment, the first and second openings 418, 420 are irrigation passageways and are disposed on an axis that is disposed orthogonally to the lengthwise axis 329 of the outer elongate member 316. As a result, fluid passing through the first and second openings 418, 420 flows from through the first and second openings 418, 420 orthogonally relative to the lengthwise axis 329 of the outer elongate member 316 and the lengthwise axis 481 of the distal tip 322.

[0172] The chassis 394 is disposed between the frame 392 and the sleeve 396. The chassis 394 defines an imaging device recess 424, a pressure sensor recess 426, a light source recess 428, a temperature sensor recess 430, and houses the imaging device 398, the pressure sensor 400, the light source 402, and the temperature sensor 404 between the chassis 394 and the sleeve 396.

[0173] In the embodiment shown, the first wire member 324 and the second wire member 326 are attached to the outer elongate member 316, as shown in FIG. 33. The outer elongate member 316 defines a first wire member key 434 and a second wire member key 436. The first wire member 324 is wrapped around the first wire member key 434 and / or welded to the first wire member key 434 and anchored to the outer elongate member 316. The second wire member 326 is wrapped around the second wire member key 436 and / or welded to the second wire member key 436 and anchored to the outer elongate member 316. The second wire member key 436 is the same as the first wire member key 434, just positioned on an opposite side of the outer elongate member 316.

[0174] The first wire member 324 is attached to the handle 320 and the outer elongate member316. The first wire member 324 has a first end 440 and a second end 442. In the embodimentshown, the first end 440 of the first wire member 324 is attached to the actuator 352 (e.g., steering drum 374) and the second end 442 of the first wire member 324 is attached to the outer elongate member 316. The first wire member 324 extends from the first end 440. around a portion of the steering drum 374, around the first rolling pin 364, around the first guide pin 360, through the manifold 338, through a first portion of the outer elongate member 316 within the interstitial space 422, radially outward of a first indentation 444 of the plurality of indentations 446, through a second portion the outer elongate member 316 within the interstitial space 422, and to the first wire member key 434.

[0175] The second wire member 326 is attached to the handle 320 and the outer elongate member 316. The second wire member 326 has a first end 448 and a second end 450. In the embodiment shown, the first end 448 of the second wire member 326 is attached to the actuator 352 (e.g., steering drum 374) and the second end 450 of the second wire member 326 is attached to the outer elongate member 316. The second wire member 326 extends from the first end 448, around a portion of the steering drum 374, around the second rolling pin 366, around the second guide pin 362, through the manifold 338, through a first portion of the outer elongate member 316 within the interstitial space 422, radially outward of a second indentation of the plurality of indentations 446, through a second portion the outer elongate member 316 within the interstitial space 422, and to the second wire member key 436.

[0176] FIGS. 42 through 45 illustrate a third example medical scope 510. The medical scope 510 has a second end 514, an outer elongate member 516, an inner elongate member 518. a distal tip 522, a first wire member 524, and a second wire member 526. The medical scope 510 is moveable between a substantially straight configuration, as shown in FIG. 42, and a deflected configuration.

[0177] In the embodiment shown, the distal tip 522 is attached to the second end 530 of the outer elongate member 516 and the second end 532 of the inner elongate member 518. In the embodiment shown, the distal tip 522 includes a frame 534, a chassis 536, a sleeve 538, an imaging device 540, a pressure sensor 542, a plurality of light sources 544, and a temperature sensor 546. The outer elongate member 516 is attached to the frame 534 and the inner elongate member 518 is attached to the chassis 536.

[0178] The frame 534 is disposed between the outer elongate member 516 and the chassis 536. The frame 534 has a first end 550, a second end 552, and defines a central passageway 554, a first recess 556, a second recess 558, a first wire member recess 560, and a second wire member recess 562. The first wire member recess 560 extends from the first recess 556 to the second end 552 of the frame 534 and receives the first wire member 524. The second wire member recess 562 extends from the second recess 558 to the second end 552 of the frame 534 and receives the second wire member 526. The first and second recesses 556, 558 are the same, just positioned on opposite sides of the frame 534. The first and second wire member recesses 560, 562 are the same, just positioned on opposite sides of the frame 534. The central passageway 554 receives the inner elongate member 518.

[0179] The chassis 536 is disposed between the frame 534 and the sleeve 538. The chassis 536 defines an imaging device and plurality of light sources recess 564, a pressure sensor recess 566, a temperature sensor recess 570, a first wire member recess 572, a second wire member recess 574, and a central channel 575. The chassis 536 houses the imaging device 540, the pressure sensor 542, the plurality of light sources 544, and the temperature sensor 546 between the chassis 536 and the sleeve 538. Each of the imaging device and plurality of light sources recess 564, the pressure sensor recess 566, and the temperature sensor recess 570 extends to the second end 514 of the medical scope 510. The central channel 575 is in communication with the central passageway 554 of the frame 534 and the inner elongate member lumen 78 of the inner elongate member 18.

[0180] In the embodiment shown, the first wire member 524 and the second wire member 526 are attached to the chassis 536. The first wire member 524 extends along the frame 534 within the first wire member recess 560 and is disposed within the first wire member recess 572 of the chassis 536. The second wire member 526 extends along the frame 534 within the second wire member recess 562 and is disposed within the second wire member recess 574 of the chassis 536.

[0181] FIGS. 46 through 64 illustrate a fourth example medical scope 610. The medical scope 610 has a first end 612, a second end 614, an outer elongate member 616, an inner elongate member 618, a handle 620, a distal tip 622, a first wire member 624, and a second wire member 626. The medical scope 610 is moveable between a substantially straight configuration, as shown in FIG. 46, a first deflected configuration, as shown in FIG. 48, and a second deflected configuration.

[0182] The outer elongate member 616 is attached to the handle 620 (e.g., hub 696) and the distal tip 622 and has a lengthwise axis 629, a first end 630, a second end 632, a first portion 634, a cuff 633, and a second portion 636. In the embodiment shown, the first portion 634 is attached to the handle 620 (e.g., hub 696) and the cuff 633, is formed of a solid braided material, and has a length 635. The cuff 633 is attached to the first portion 634 and the second portion 636. The second portion 636 is attached to the cuff 633 and the distal tip 622. This structural arrangement provides a mechanism for the first portion 634 to transmit torque forces to the distal tip 622 at, or close to, a 1 to 1 ratio.

[0183] The second portion 636 has a length 637, a lengthwise axis 639, a first end 638, a second end 640, a first side 642, a second side 644, a tubular shaft 646, and a jacket 648. The length 637 of the second portion 636 is less than the length 635 of the first portion 634. In the embodiment shown, the length 637 is about 10cm. However, in alternative embodiments, a length of a second portion can be greater than, or less than, 10cm. The tubular shaft 646 extends between the first end 638 and the second end 640. The second end 640 is attached to the distal tip 622. The first side 642 opposably faces the second side 644 relative to the lengthwise axis 629.

[0184] The tubular shaft 646 has an outer surface 650, an inner surface 652, an outer diameter 653, and a circumferential wall 647 that defines an inner lumen 654, a plurality of indentations 656, a first alignment projection 658, a second alignment projection 660, and a plurality of slits 662. Each of the first alignment projection 658 and the second alignment projection 660 extends into the inner lumen 654. The first alignment projection 658 defines a passageway 663 that receives the first wire member 624. The second alignment projection 660 defines a passageway 664 that receives the second wire member 626. The jacket 648 covers the circumferential wall 647 and each slit of the plurality of slits 662. In the embodiment shown, the jacket 648 completely surrounds the circumferential wall 647, prevents fluid (e.g., irrigation fluid) from passing through the plurality of slits 662, and provides a surface that reduces friction while the medical scope 610 traverses the bodily passage (e.g., urinary tract).

[0185] In the illustrated embodiment, and as shown in FIGS. 53 and 54, the plurality of slits 662 includes single slits 802 and sets of double slits 804. Each single slit 802 partially extends around the circumference of the second portion 636, has a circumferential length 641, and has a first endportion 806 and a second end portion 808. Except for the single slits 802 at each end of the tubular shaft 646, the first end portion 806 of each single slit 802 is axially adjacent to the second end portion 808 of two other single slits 802. A first slit 810 of the single slits 802 has first end 812 disposed on a first axis 813 that is parallel to the lengthwise axis 639 of the second portion 636. A second slit 814 of the single slits 802 has a first end 816 disposed on a second axis 817 that is parallel to the lengthwise axis 639 of the second portion 636 and different than, and non-coaxial with, the first axis 813. The single slits 802 alternate the side of the second portion 636 on which they are disposed such that a first set 818 of the single slits 802 is disposed on a first side 820 of the second portion 636 and a second set 822 of the single slits 802 is disposed on a second side 824 of the second portion 636.

[0186] Each slit in a set of double slits 804 is axially adjacent, partially extends around the circumference of the second portion 636, has a circumferential length 643, and has a first end 830 and a second end 832. As shown in FIGS. 53, except for the sets 834 of double slits 804 at the second end 640 of the second portion 636, each set of double slits 804 is disposed between two single slits 802 and circumferentially adjacent to a single slit 802. Except for the sets 834 of double slits 804 at the second end 640 of the second portion 636, the first end 830 and the second end 832 of each slit in a set of double slits 804 is axially adjacent to a first single slit 836 of the single slits 802, axially adjacent another slit in the set of double slits 804, and circumferentially adjacent to a second single slit 838 of the single slits 802 that is different than the first single slit 836. The sets of double slits 804 alternate the side of the second portion 636 on which they are disposed such that a first set 840 of the sets of double slits 804 are disposed on the first side 820 of the second portion 636 and a second set 842 of the sets of double slits 804 are disposed on the second side 824 of the second portion 636. The first end 830 of each slit in a set of double slits 804 is disposed on a first axis 841 that is parallel to the lengthwise axis 639 of the second portion 636. The second end 832 of each slit in a set of double slits 804 is disposed on a second axis 843 that is parallel to the lengthwise axis 639 of the second portion 636 and different than, and non-coaxial with, the first axis 841.

[0187] Each set of double slits 804 is utilized to create an indentation of the plurality of indentations 656. This is accomplished by moving a portion 850 of the second portion 636 disposed between the slits in a set of double slits 804 radially inward and toward the lengthwiseaxis 639 of the second portion 636. As a result, the portion 850 of the second portion 636 is disposed a first distance 851 from the lengthwise axis 639 of the second portion 636 and a second portion 852 of the second portion 636 that is not moved radially inward is disposed a second distance 853 from the lengthwise axis 639 that is greater than the first distance 851.

[0188] The inner elongate member 618 is attached to the handle 620 and the distal tip 622, is disposed within, and partially extends through, the handle 620 (e.g., the hub 696), and is disposed within, and partially extends through, the outer elongate member 616. In the embodiment shown, the inner elongate member 618 extends through the first portion 634, the inner lumen 654 of the second portion 636, and is attached to the distal tip 622. The inner elongate member 618 has a central axis 669, a first end 674, a second end 676, and defines an inner elongate member lumen 678 (e.g., suction channel) that has an inside diameter 679. In the embodiment shown, the first end 674 is attached to the suction control 700 such that the inner elongate member lumen 678 is in fluid communication with the central passageway 736 defined by the suction control 700. In the embodiment shown, the second end 676 is attached to the main body 760 of the distal tip 622. In the embodiment shown, the inside diameter 679 is about 2mm. However, in alternative embodiments, an inside diameter of an inner elongate member can be greater than, or less than, 2mm. During use, suction can be applied to the inner elongate member lumen 678 to remove small laser-generated particulate, without a laser fiber disposed within the inner elongate member lumen 678, and while the medical scope 610 is in the substantially straight configuration or a deflected configuration. A laser fiber 611 is shown disposed through the interstitial space 684 and through the distal tip 622 in FIGS. 49 and 50.

[0189] An interstitial space 684 is defined between the outer elongate member 616 and the inner elongate member 618 and extends from the handle 620 (e.g., hub 696) to the first and second irrigation passageways 774, 776 defined by the main body 760 of the distal tip 622. The interstitial space 684 provides a pathway for irrigation fluid to travel from the handle 620 to the distal tip 622.

[0190] The handle 620 is disposed on the first end 630 of the outer elongate member 616. The handle 620 defines a chamber 690 and has a lengthwise axis 689, a first end 692, a second end 694, a hub 696, a medical device tubular member 698, and a suction control 700. A wire port, a baffle, an actuator, and a circuit board have been omitted for clarity, but can be included as describedherein. In embodiments in which a circuit board is included, a wire harness can extend from the circuit board, through the hub 696 (e.g., valve 708), and to the distal tip 622. A handle included in a medical scope can be manufactured using any suitable technique or method of manufacture and selection of a suitable technique or method can be based on various considerations, such as the material(s) used to form a handle. Examples of techniques and methods considered suitable to manufacture a handle include injection molding, forming a handle of two halves and attaching the two halves to one another using adhesive and / or threaded fasteners, and any other method considered suitable for a particular embodiment.

[0191] Each of the hub 696, the medical device tubular member 698, and the suction control 700 is housed within the chamber 690. The hub 696 has a main body 706. a valve 708. and a cap 710. The main body 706 has a first end 712, a second end 714, and defines a central passageway 716, and an irrigation port 718 that is in fluid communication with the central passageway 716. The central passageway 716 is in fluid communication with the interstitial space 684 between the outer elongate member 616 and the inner elongate member 618. Irrigation fluid can be passed through the irrigation port 718 and supplied to the interstitial space 684.

[0192] The valve 708 is disposed between the main body 706 and the cap 710 and, in the illustrated embodiment, is a one-way valve formed of rubber. However, in alternative embodiments, a valve can be formed of any suitable material capable of providing a leak-proof seal around components passing through the valve (e.g., wire members, wire harness, medical device tubular member 698. inner elongate member 618). The valve 708 defines an inner elongate member passageway 720, a medical device tubular member passageway 722, a first wire member passageway 724, and a second wire member passageway 726. The cap 710 is attached to the main body 706.

[0193] The medical device tubular member 698 extends from an environment exterior 621 to the handle 620 through the central passageway 716 of the hub 696 and is attached to the distal tip 622. The medical device tubular member 698 defines a passageway 728 through which a secondary device (e.g., laser fiber, stone basket, guidewire) can be passed and treatment implemented. In this embodiment, the secondary device is passed to the second end 614 of the medical scope outsideof the inner elongate member lumen 678 allowing the inner elongate member lumen 678 to be a dedicated pathway for larger stone fragments to be removed from a bodily passage.

[0194] The suction control 700 includes a main body 730 and an actuator 732. The inner elongate member 618 is attached to the main body 730. The actuator 732 is configured to selectively permit and block suction through the inner elongate member 618 with movement of the actuator 732, as described in more detail herein. The first end 674 of the inner elongate member 618 is attached to the main body 730 of the suction control 700 and extends through the hub 696 (e.g., inner elongate member passageway 720). The main body 730 has a central passageway 736, an actuator recess 738, and a vents 741. The central passageway 736 has a first end 740, a second end 742, a first portion 744 and a second portion 746. The central passageway 736 is in fluid communication with the inner elongate member lumen 678 of the inner elongate member 618. The first portion 744 extends from the first end 740 to the actuator recess 738. The second portion 746 extends from the actuator recess 738 to the second end 742. The first portion 744 has a first inside diameter 745 and the second portion 746 has a second inside diameter 747 that is less than the first inside diameter 745. The actuator recess 738 extends from a sidewall 748 of the handle 620 to a recess base 750. Each vent 741 extends through the main body 730 and provides access to the actuator recess 738 and prevents a complete vacuum from being formed during use.

[0195] The actuator 732 is disposed within the actuator recess 738 and is moveable between a first position, as shown in FIG. 57, and a second position, as shown in FIG. 58. The actuator 732 has a first end 752, a second end 754, and defines a passageway 756 disposed between the first and second ends 752, 754. The passageway 756 extends along an axis 755 that is parallel to the central passageway 736 of the main body 730. The passageway 756 has a length 757 that is greater than the first inside diameter 745 of the central passageway 736 of the main body 730. In the embodiment shown, the passageway 756 has a length 757 that is greater than the sum of the first inside diameter 745 of the central passageway 736 of the main body 730 and the length 759 of a portion of the handle 620 disposed between the main body 730 and an environment exterior 621 to the chamber 690 of the handle 620.

[0196] In the first position, as shown in FIG. 57, and when no force is being applied to the actuator 732, the passageway 756 is in fluid communication with both the central passageway 736of the main body 730 and the environment exterior 621 to the central passageway 736 and the chamber 690 of the handle 620. In this position, a first portion 751 of the length 757 of the passageway 756 is exposed to the environment exterior 621 to the central passageway 736 and the chamber 690 of the handle 620. This structural arrangement allows for ambient air to enter into the suction control 700 such that no suction is applied at the distal tip 622.

[0197] In the second position, as shown in FIG. 58, and when force is applied to the actuator 732 and toward the lengthwise axis 689 of the handle 620 such that the actuator 732 is fully depressed, the passageway 756 is in fluid communication with only the central passageway 736 of the main body 730 and the vents 741. In this position, only the vents 741 are exposed to the environment exterior 621 to the central passageway 736 and the chamber 690 of the handle 620. This structural arrangement prevents most ambient air from entering the suction control 700 such that suction is applied at the distal tip 622.

[0198] In a position between the first position and the second position, when force is applied to the actuator 732 and toward the lengthwise axis 689 of the handle 620 such that the actuator 732 is partially depressed, the passageway 756 is in fluid communication with both the central passageway 736 of the main body 730 and the environment exterior 761 to the chamber 690 of the handle 620. In this position, a second portion of the length 757 of the passageway 756 is exposed to the environment exterior 621 to the central passageway 736 and the chamber 690 of the handle 620. The second portion being less than the first portion 751. This structural arrangement allows for a smaller amount of ambient air to enter into the suction control 700 such that more suction is applied at the distal tip 622 relative to the first position and less suction is applied at the distal tip 622 relative to the second position. As a result, an adjustable, variable suction control 700 is provided for controlling the removal of material (e.g., irrigation fluid, stone debris) located distal to the distal tip 622. By compressing the actuator 732, the user increases the strength of suction applied at the distal tip 622 until full suction is achieved when the actuator 732 is fully depressed and in the second position.

[0199] The distal tip 622 is attached to the second end 632 of the outer elongate member 616, the second end 676 of the inner elongate member 618, and the medical device tubular member 698. In the embodiment shown, the distal tip 622 has a main body 760 that has a first end 762, a secondend 764, and defines an inner elongate member passageway 766, an outer elongate member recess 768, an imaging device passageway 770, a light source passageway 772, a first irrigation passageway 774, a second irrigation passageway 776, a shoulder 778, and a secondary device passageway 781 in communication with the passageway 728 defined by the medical device tubular member 698. The main body 760 tapers from a location 779 at the second end 764 and toward the first end 762. Each of the inner elongate member passageway 766, the imaging device passageway 770, the light source passageway 772, the first irrigation passageway 774, and the second irrigation passageway 776 extends through the main body 760.

[0200] The inner elongate member 618 is partially disposed within the distal tip 622 and is in fluid communication with the inner elongate member passageway 766. The outer elongate member 616 is partially disposed within the distal tip 622 and is in fluid communication with the first irrigation passageway 774 and the second irrigation passageway 776. Each of the imaging device passageway 770 and the light source passageway 772 is in fluid communication with the interstitial space 684. The imaging device passageway 770 receives an imaging device and the light source passageway 772 receives a light source. Each of the first irrigation passageway 774 and a second irrigation passageway 776 is in fluid communication with the interstitial space 684 and receives irrigation fluid passed through the irrigation port 718. In the illustrated embodiment, the first and second irrigation passageways 774, 776 extend parallel to the lengthwise axis 629 of the outer elongate member 616 and parallel to the lengthwise axis 783 of the distal tip 622. The first and second irrigation passageways 774, 776 extend from the shoulder 778 to the second end 764. During use, irrigation fluid travels from a source connected to the irrigation port 718, through the handle 620, through the interstitial space 684, through the first and second irrigation passageways 774, 776, and flows from the irrigation passageways 718, 720 parallel to the lengthwise axis 629 of the outer elongate member 616, parallel to the lengthwise axis 783 of the distal tip 622, and into a bodily passage. The shoulder 778 is disposed between the first end 762 and the second end 764. The outer elongate member 616 is disposed adjacent to the shoulder 778.

[0201] The first wire member 624 includes a first spring tube 780 partially disposed over the first wire member 624. The first spring tube 780 extends from the hub 696 to the cuff 633. The second wire member 626 includes a second spring tube 782 partially disposed over the second wire member 626. The second spring tube 782 extends from the hub 696 to the cuff 633. Thesecond end 784 of the first wire member 624 and the second end 786 of the second wire member 626 is attached to the distal tip 622 at the shoulder 778. A spring tube can comprise any suitable structure (e.g., compression tubes, compression springs) capable of surrounding a wire member, providing a conduit for the wire member, and / or providing additional stiffness along a portion of a length of a wire member. The inclusion of a spring tube provides additional support along an outer elongate member and an inner elongate member such that the portion of the outer elongate member and the portion of the inner elongate member disposed proximal to a cuff are maintained in a substantially straight configuration and such that deflection of the outer elongate member and the inner elongate member are limited to the portion of the outer elongate member and the portion of the inner elongate member that are disposed distal to the cuff. In addition, the inclusion of a spring tube allows a wire member to remain in tension, while also providing flexibility along an outer elongate member and an inner elongate member.

[0202] The medical scopes described herein provide structure (e.g., relatively large working channels capable of suction, which reduce the number of devices necessary to perform treatment) for removing small particulate generated during treatment within a bodily passage, while also providing mechanisms for computing temperature and pressure within the bodily passage. In addition, the ability to create favorable flow patterns by concurrently applying suction and irrigation at the second end of the medical scope enables a practitioner to clear the field of view and remove particles disposed within the bodily passage. The medical scopes described herein enable procedures to be completed more quickly relative to procedures using currently existing medical scopes and / or traditional methods of fragment removal. In addition, the medical scopes described herein provide structure for navigating the medical scope through the tortuous anatomy of the human body, such as generally difficult to reach calices within the renal cavity.

[0203] Various methods of using a medical scope are described herein. While the methods described herein are shown and described as a series of acts, it is to be understood and appreciated that the methods are not limited by the order of acts, as some acts may, in accordance with these methods, occur in the order shown and / or described, in different orders, concurrently with other acts described herein, or be omitted from a method of using a medical scope.

[0204] Figure 65 is a schematic representation of an exemplary method 900 of using a medical scope. In the illustrated embodiment, the method 900 relates to performing laser lithotripsy to remove a stone disposed in the urinary tract.

[0205] An initial step 902 comprises inserting a medical scope having a first end and a second end through an external urethral orifice such that the medical scope second end is disposed past the external urethral orifice, in the urethra, and within the urinary tract. The medical scope defines a lumen. Another step 904 comprises advancing the medical scope to a stone disposed within the urinary tract. Another step 906 comprises inserting a lithotripter comprising a firing handle and a probe having a probe proximal end and a probe distal end through the lumen of the medical scope such that the probe distal end is disposed distal to the second end of the medical scope. Another step 908 comprises navigating the probe distal end towards the stone. Another step 910 comprises contacting the probe distal end to the stone. Another step 912 comprises applying irrigation to the second end of the medical scope. Another step 914 comprises applying suction to the second end of the medical scope. Another step 916 comprises activating the firing handle to transmit energy through the probe and to the stone to fragment the stone. Another step 918 comprises confirming removal of the stone fragments from the urinary tract. Another step 920 comprises removing the probe from the lumen of the scope. Another step 922 comprises removing the medical scope from the urinary tract and the external urethral orifice.

[0206] The step 902 of inserting a medical scope having a first end and a second end through an external urethral orifice such that the second end of the medical scope is disposed past the external urethral orifice, in the urethra, and within the urinary tract can be accomplished by locating the external urethral orifice and applying a force on the medical scope directed toward the external urethral orifice until the second end of the medical scope is inserted into and through the external urethral orifice. Step 902 can be accomplished using any suitable medical scope according to an embodiment, such as those described herein.

[0207] An optional step that can be completed prior to step 902 comprises inserting a sheath having a sheath proximal end and a sheath distal end through an external urethral orifice such that the sheath distal end is disposed past the external urethral orifice and in the urethra and can be accomplished by locating the external urethral orifice and applying a force on the sheath directed toward the external urethral orifice until the sheath distal end is inserted into and through theexternal urethral orifice. While this optional step has been described as using a sheath to provide access to a urinary tract, other devices and bodily passages are considered suitable to utilize in combination with the medical scopes described herein. Selection of a suitable device and / or bodily passage can be based on various considerations, such as the desired treatment intended to be performed. When a sheath is utilized, step 902 comprises inserting a medical scope having a first end and a second end through the sheath lumen such that the second end of the medical scope is disposed distal to the sheath distal end and within the urinary tract. When a sheath is utilized, step 902 can be accomplished by locating the sheath proximal opening and applying a force on the medical scope directed toward the sheath proximal opening until the second end of the medical scope is inserted into and through the sheath lumen.

[0208] The step 904 of advancing the medical scope to a stone disposed within the urinary tract can be accomplished by applying a force on the medical scope directed toward the external urethral orifice and the urinary tract until the second end of the medical scope is disposed adjacent to, or contacts, the stone. This step 904 can be accomplished while directly visualizing the urinary tract and / or stone during advancement of the medical scope using the visualization devices described herein. FIG. 66 illustrates a medical scope 950 disposed within a urethra 952, a bladder 954, a ureter 956, and a renal cavity 958. The second end 960 of the medical scope 950 is disposed adjacent to a stone 962.

[0209] The step 906 of inserting a lithotripter comprising a firing handle and a probe through the lumen of the medical scope such that the probe distal end is disposed distal to the second end of the medical scope can be accomplished by locating the first port or medical device tubular member on a handle of a medical scope and applying a force on the lithotripter directed toward the first port or medical device tubular member until the probe distal end is inserted into and through the medical scope. Examples of lithotripters considered suitable to perform one or more steps, or methods, described herein include, but are not limited to, laser lithotripters, and any other lithotripter considered suitable for a particular application.

[0210] The step 908 of navigating the probe distal end towards the stone can be accomplished by applying a force on the lithotripter directed toward the sheath and / or urinary tract until the probe distal end is disposed adjacent to the stone. This step 908 can be accomplished while directly visualizing the urinary tract and / or stone during advancement of the probe using the visualizationdevices described herein. This step can be accomplished by navigating the probe to a stone disposed in any suitable bodily passage, such as the bladder, ureter, and / or kidney.

[0211] The step 910 of contacting the probe distal end with the stone can be accomplished by applying a force on the lithotripter directed toward the medical scope and / or urinary tract until the probe distal end contacts the stone. This step can be accomplished using direct visualization and / or through tactile feedback through the probe and / or handle of the medical scope. Alternatively, a probe distal end can be positioned adjacent to a stone and not contacting the stone.

[0212] The step 912 of applying irrigation to the second end of the medical scope can be accomplished by activating an irrigation device operatively connected to the handle of the medical scope such that irrigation fluid (e.g., water, saline) is transferred to the second end of the medical scope, as described herein.

[0213] The step 914 of applying suction to the second end of the medical scope can be accomplished by activating a suction device operatively connected to the handle of the medical scope such that suction is applied to the second end of the medical scope, as described herein. This step 914 can be accomplished concurrently with, or separately from, step 912. Steps 912 and 914 can be completed prior to step 902, prior to introducing a medical scope into a sheath, or prior to step 916. Optionally, step 912 and / or 914 can be completed concurrent with step 916. Completion of step 912 and / or step 914 provide(s) a mechanism for expanding the renal cavity, cooling the treatment site, and / or clearing stone particles during treatment to maintain a clear field of vision.

[0214] The step 916 of activating the firing handle to transmit energy through the probe and to the stone to fragment the stone can be accomplished by applying force on the firing handle of the lithotripter such that it activates the lithotripter. FIG. 67 illustrates the medical scope 950 disposed within a renal cavity 958. Irrigation and suction are being applied within the renal cavity 958 concurrently such that stone particles 964 can be removed from the renal cavity 958. Arrows 966 illustrate the flow pattern of irrigation fluid exiting the medical scope 950, traveling through the renal cavity 958, and being drawn into the medical scope 950 using suction.

[0215] The step 918 of confirming removal of the stone fragments from the urinary tract can be accomplished by directly visualizing the urinary tract and / or stone during using the visualization devices described herein.

[0216] The step 920 of removing the probe from the lumen of the medical scope can be accomplished by applying a force on the probe directed away from the medical scope until the probe is completely removed from the urinary tract and the medical scope. Optionally, this step can be completed subsequent to step 922.

[0217] The step 922 of removing the medical scope from the urinary tract and the external urethral orifice can be accomplished by applying a force on the medical scope directed away from the external urethral orifice until the medical scope is completely removed from the urinary tract and the urethra.

[0218] In embodiments in which a sheath is utilized, alternative steps comprise removing the medical scope from the sheath lumen and another step comprises removing the sheath from the urinary tract and the external urethral orifice. The first alternative step can be accomplished by applying a force on the medical scope directed away from the sheath until the medical scope is completely removed from the urinary tract and the sheath. The second alternative step can be accomplished by applying a force on the sheath directed away from the external urethral orifice until the sheath is completely removed from the urinary tract and the urethra. Optionally, these alternative steps can be accomplished concurrently.

[0219] An optional step comprises inserting a guidewire having a guidewire proximal end and a guidewire distal end through an external urethral orifice such that the guidewire distal end is disposed past the external urethral orifice and in the urethra. This optional step can be accomplished prior to any initial step such that the sheath and / or medical scope can be tracked over the guidewire. This optional step can be accomplished by locating the external urethral orifice and applying a force on the guidewire directed toward the external urethral orifice until the guidewire distal end is inserted into and through the external urethral orifice.

[0220] FIGS. 68 through 88 illustrate embodiments of a distal tip that can be included in a medical scope, such as those described herein. Current devices, such as ureteroscopes, typically have a working channel that is used as an irrigation port and is front facing on the distal end of the device. When irrigation fluid is expelled from this channel, it scatters smaller fragments and particles that are created via laser lithotripsy, creating what is called a “snow globe effect.” As a result, a user’s vision can become impaired, requiring the procedure to be paused until a sufficientnumber of particles have been flushed out of the field of view, and adequate vision is restored. By including irrigation passageways that are disposed orthogonal, or angled, relative to a lengthwise axis of an outer elongate member, a lengthwise axis of a distal tip, or a second end (e.g., front face) of a distal tip, while also providing structure for concurrently performing suction with irrigation, the embodiments described herein provide a mechanism for directing irrigation fluid flow away from the irrigation passageways, laterally in some embodiments, into an environment exterior to the medical scope, which forces particles out of the field of view during use, thus preventing impairments to the field of visions, obviating the need to wait for vision to be restored, and reducing the time required to perform the procedure.

[0221] FIGS. 68 and 69 illustrate an alternative distal tip 1002 that can be included in a medical scope, such as those described herein.

[0222] In the illustrated embodiment, the distal tip 1002 has a lengthwise axis 1003 and a main body 1004. The main body 1004 has a first end 1006, a second end 1008, an outside diameter 1009, and defines an inner elongate member passageway 1010, an outer elongate member recess 1012, an imaging device passageway 1014, a light source passageway 1016, and a plurality of irrigation passageways 1018. The main body 1004 tapers from a location 1005 between the first end 1006 and the second end 1008 and toward the second end 1008 defining a tapered sidewall 1007. This structural arrangement allows greater access to the inner elongate member such that particles and fragments can be removed during use. Each of the inner elongate member passageway 1010, the imaging device passageway 1014, the light source passageway 1016, and each passageway of the plurality of irrigation passageways 1018 extends through the main body 1004 and provides access to the outer elongate member recess 1012. As shown in FIG. 68 and 69, the inner elongate member passageway 1010 is defined on both the second end 1008 and the tapered sidewall 1107. This allows for suction to be applied through the inner elongate member passageway 1010 along an axis 1011 that is parallel to the lengthwise axis 1003 of the distal tip 1302 and along an axis 1013 that is disposed at an angle relative to the lengthwise axis 1003 of the distal tip 1002. The main body 1004 defines a curved surface 1015 around the perimeter of the inner elongate member passageway 1010, which allows for fluid to pass into the inner elongate member passageway 1010 along the curved surface 1015, or tangentially relative to the curved surface 1015, when suction is being applied to the inner elongate member passageway 1010.

[0223] Each passageway of the plurality of irrigation passageways 1018 has a central axis 1019 disposed orthogonally to the lengthwise axis 1003. However, in alternative embodiments, a central axis of an irrigation passageway can be disposed at any suitable angle relative to a lengthwise axis of a distal tip. In the embodiment shown, the plurality of irrigation passageways 1018 includes six irrigation passageways. Irrigation fluid can pass through the plurality of irrigation passageways 1018 and flow from the irrigation passageways 1018, away from the lengthwise axis 1003 of the distal tip 1002, and into an environment exterior to the distal tip 1002 (e.g., medical scope). In the embodiment shown, fluid can pass through the plurality of irrigation passageways 1018 and flow from the irrigation passageways 1018, laterally, or orthogonally, relative to the lengthwise axis 1003 of the distal tip 1002, and into an environment exterior to the distal tip 1002 (e.g., medical scope). However, alternative embodiments can include any suitable number of irrigation passageways, such as one, two, a plurality, three, four, five, six, and more than six.

[0224] When attached to an outer elongate member and an inner elongate member, as described herein, the outer elongate member is partially disposed within the distal tip 1002 and the inner elongate member is partially disposed within the distal tip 1002. The distal tip 1002 can be attached to a second end of an outer elongate member such that the outer elongate member is in fluid communication with the plurality of irrigation passageways 1018. This can be accomplished by positioning a portion of the outer elongate member within the outer elongate member recess 1012 and attaching the outer elongate member to the distal tip 1002 using adhesive, or any other technique or method of attachment, such as those described herein. The distal tip 1002 can be attached to a second end of an inner elongate member such that the inner elongate member is in fluid communication with the inner elongate member passageway 1010. This can be accomplished by positioning a portion of the inner elongate member within the inner elongate member passageway 1010 and attaching the inner elongate member to the distal tip 1002 using adhesive, or any other technique or method of attachment, such as those described herein.

[0225] When attached to an outer elongate member and an inner elongate member, each of the imaging device passageway 1014, the light source passageway 1016, and each passageway of the plurality of irrigation passageways 1018 is in fluid communication an interstitial space disposed between the outer elongate member and the inner elongate member. During use, each passageway of the plurality of irrigation passageways 1018 can receive an irrigation fluid passed through anirrigation port, through the interstitial space or one or more tubular members, and pass the irrigation fluid to an environment 1021 exterior to the distal tip 1002 (e.g., medical scope). FIG. 69 illustrates a flow pathway 1020 of irrigation fluid being passed through the distal tip 1002 (e.g., outer elongate member recess 1012) and each passageway of the plurality of irrigation passageways 1018.

[0226] FIG. 70 illustrates an alternative distal tip 1052 that can be included in a medical scope, such as those described herein. The distal tip 1052 is similar to distal tip 1002, except as described and illustrated. In the embodiment shown, the distal tip 1052 has a projection 1053. The main body 1054 has first outside diameter 1059 and a second outside diameter 1061. The first outside diameter 1059 extends from the first end 1056 toward the second end 1058, partially around the circumference of the main body 1054, to a location 1063 disposed between the first end 1056 and the second end 1058. The second outside diameter 1061 extends from the second end 1058 toward the first end 1056 to the location 1063. The second outside diameter 1061 is less than the first outside diameter 1059. This structural arrangement provides a mechanism for reducing the outside diameter of the distal tip at the distal end, allowing greater access to the inner elongate member such that particles and fragments can be removed during use.

[0227] FIGS. 71, 72, and 73 illustrate an alternative distal tip 1102 that can be included in a medical scope, such as those described herein. Distal tip 1102 is similar to distal tip 1002, except as described and illustrated.

[0228] In the illustrated embodiment, the distal tip 1102 has a lengthwise axis 1103 and a main body 1104. The main body 1104 has a first end 1106, a second end 1108, a first outside diameter 1109, a second outside diameter 1111, and defines a non-circular inner elongate member passageway 1110, an outer elongate member recess 1112, a device passageway 1114, a plurality of wire member passageways 1116, and a plurality of irrigation passageways 1118. A portion of the second end 1108 of the main body 1104 tapers from a location 1105 on the second end 1108 and toward the first end 1106. Each of the inner elongate member passageway 1110, the device passageway 1114, the plurality of wire member passageways 1116, and each passageway of the plurality of irrigation passageways 1118 extends through the main body 1104 and provides access to the outer elongate member recess 1112. The device passageway 1114 houses an imaging device1130 and a plurality of light sources 1 132. Each passageway of the plurality of wire member passageways 1116 receives a wire member 1134, such as those described herein. A portion 1121 of each passageway of the plurality of irrigation passageways 1118 has a central axis 1119 that is disposed orthogonally to the lengthwise axis 1103. However, in alternative embodiments, a portion of an irrigation passageway can have a central axis disposed at any suitable angle relative to a lengthwise axis of a distal tip. The main body 1104 defines a curved surface 1115 around the perimeter of each irrigation passageway of the plurality of irrigation passageways 1118, which allows for irrigation fluid to advance out of the irrigation passageways 1118 along the curved surface 1115, or tangentially relative to the curved surface 1115, when irrigation fluid is being passed through the irrigation passageways 1118.

[0229] When attached to an outer elongate member 1136 and an inner elongate member 1138, each of the device passageway 1114, each passageway of the plurality of wire member passageways 1116, and each passageway of the plurality of irrigation passageways 1118 is in fluid communication an interstitial space disposed between the outer elongate member and the inner elongate member. As shown, each passageway of the plurality of irrigation passageways 1118 has a rectangular cross-section and is in fluid communication with a tubular member 1140 that receives an irrigation fluid passed through an irrigation port and passes the irrigation fluid to an environment 1123 exterior to the distal tip 1102 (e.g., medical scope). Irrigation fluid can pass through the plurality of irrigation passageways 11 18 and flow from the irrigation passageways 1118, away from the lengthwise axis 1103 of the distal tip 1102, and into an environment exterior to the distal tip 1102 (e.g., medical scope). In the embodiment shown, fluid can pass through the plurality of irrigation passageways 1118 and flow from the irrigation passageways 1118, laterally, or orthogonally, relative to the lengthwise axis 1103 of the distal tip 1102, and into an environment exterior to the distal tip 1102 (e.g.. medical scope). Alternatively, each passageway of a plurality of irrigation passageways can have any suitable cross-sectional shape and be in fluid communication with an interstitial space that receives an irrigation fluid passed through an irrigation port and pass the irrigation fluid to an environment exterior to a distal tip (e.g., medical scope). In any embodiment described herein an opening (e.g., irrigation opening) can optionally be in fluid communication with an interstitial space and / or a tubular member attached to an irrigation device to receive irrigation fluid.

[0230] FIG. 74 illustrates an alternative distal tip 1 152 that can be included in a medical scope, such as those described herein. The distal tip 1152 is similar to distal tip 1102 and has a lengthwise axis 1153 and a main body 1154. The main body 1154 has a projection 1157, a first end 1156, a second end 1158, a first outside diameter 1159, a second outside diameter 1161, and defines an inner elongate member passageway 1160, an outer elongate member recess 1162, and a plurality of irrigation passageways 1168. The main body 1154 tapers from a location 1155 between the first end 1156 and the second end 1158 and toward the second end 1158.

[0231] In the embodiment shown, the first outside diameter 1159 extends from the first end 1156 toward the second end 1158, partially around the circumference of the main body 1154, and to a location 1163 disposed between the first end 1156 and the second end 1158. The second outside diameter 1161 extends from the location 1155 toward the first end 1156 to the location 1163. The second outside diameter 1161 is less than the first outside diameter 1159. This structural arrangement provides a mechanism for reducing the outside diameter of the distal tip at the distal end, allowing greater access to the inner elongate member such that particles and fragments can be removed during use.

[0232] FIG. 75 illustrates an alternative distal tip 1172 that can be included in a medical scope, such as those described herein. The distal tip 1172 is similar to distal tip 1102 and has a lengthwise axis 1173 and a main body 1174. In the illustrated embodiment, when the distal tip 1172 is attached to an outer elongate member 1190 and an inner elongate member 1192. The second end 1194 of the inner elongate member 1192 is disposed distal to the distal tip 1172 (e.g., outside of the distal tip 1172). As shown, the second end 1194 of the inner elongate member 1192 is tapered. This structural arrangement allows for a portion of the inner elongate member 1 192 to be positioned within an imaging device’s field of view to allow a user to determine whether any obstructions exist.

[0233] FIGS. 76 and 77 illustrate an alternative distal tip 1202 that can be included in a medical scope, such as those described herein. The distal tip 1202 is similar to distal tip 1002, except as described and illustrated.

[0234] In the illustrated embodiment, the distal tip 1202 has a lengthwise axis 1203 and a main body 1204. The main body 1204 has a first end 1206, a second end 1208, an outside diameter 1209,and defines an inner elongate member passageway 1210, an outer elongate member recess 1212, an imaging device passageway 1214, a light source passageway 1216, and an irrigation passageway 1218. Each of the inner elongate member passageway 1210, the imaging device passageway 1214, the light source passageway 1216, and the irrigation passageway 1218 extends through the main body 1204 and provides access to the outer elongate member recess 1212. The irrigation passageway 1218 has a central axis 1219 that is disposed parallel to the lengthwise axis 1203. However, in alternative embodiments, a central axis of an irrigation passageway can be disposed at any suitable angle relative to a lengthwise axis of a distal tip. In the embodiment shown, the irrigation passageway 1218 has a circular cross- section. However, in alternative embodiments, an irrigation passageway can have any suitable cross-sectional shape, such as rectangular, circular, and any other shape considered suitable for a particular embodiment.

[0235] During use, the irrigation passageway 1218 can receive an irrigation fluid passed through an irrigation port, through an interstitial space, and pass the irrigation fluid to an environment 1221 exterior to the distal tip 1202 (e.g., medical scope). Irrigation fluid can pass through the irrigation passageway 1218 and flow from the irrigation passageway 1218, parallel to lengthwise axis 1203 of the distal tip 1202, and into an environment exterior to the distal tip 1202 (e.g., medical scope). The main body 1204 defines a curved surface 1205 around the irrigation passageway 1218, which allows for irrigation fluid to advance out of the irrigation passageway 1218 along the curved surface 1205, or tangentially relative to the curved surface 1205, when irrigation fluid is being passed through the irrigation passageway 1118. FIG. 77 illustrates a flow pathway 1220 of irrigation fluid being passed through the distal tip 1202 (e.g.. outer elongate member recess 1212) and the irrigation passageway 1218.

[0236] FIG. 78 illustrates an alternative distal tip 1252 that can be included in a medical scope, such as those described herein. The distal tip 1252 is similar to distal tip 1202, except as described and illustrated. In the embodiment shown, the distal tip 1252 has a projection 1253, a first outside diameter 1259, and a second outside diameter 1261. The first outside diameter 1259 extends from the first end 1256 toward the second end 1258, partially around the circumference of the distal top 1202, to a location 1263 disposed between the first end 1256 and the second end 1258. The second outside diameter 1261 extends from a location between the second end 1258 and the projection 1253 toward the first end 1256 to the location 1263. The second outside diameter 1261 is less thanthe first outside diameter 1259. This structural arrangement provides a mechanism for reducing the outside diameter of the distal tip at the distal end, allowing greater access to the inner elongate member such that particles and fragments can be removed during use.

[0237] FIGS. 79 and 80 illustrate an alternative distal tip 1302 that can be included in a medical scope, such as those described herein. The distal tip 1302 is similar to distal tip 1002, except as described and illustrated.

[0238] In the illustrated embodiment, the distal tip 1302 has a lengthwise axis 1303 and a main body 1304. The main body 1304 has a first end 1306, a second end 1308, an outside diameter 1309, and defines an inner elongate member passageway 1310, an outer elongate member recess 1312, an imaging device passageway 1314, a light source passageway 1316, and a plurality of irrigation passageways 1318. Each of the inner elongate member passageway 1310, the imaging device passageway 1314, the light source passageway 1316, and each passageway of the plurality of irrigation passageways 1318 extends through the main body 1304 on the second end 1308 and provides access to the outer elongate member recess 1312. The opening 1311 of the inner elongate member passageway 1310 has a minority portion defined by a tapered sidewall 1323 of the main body 1304 and a majority portion defined on the second end 1308 of the distal tip 1302. Each irrigation passageway of the plurality of irrigation passageways 1318 has a central axis 1319 that is disposed parallel to the lengthwise axis 1303. However, in alternative embodiments, a central axis of an irrigation passageway can be disposed at any suitable angle relative to a lengthwise axis of a distal tip. The opening 1325 of each irrigation passageway of the plurality of irrigation passageways 1318 and has a majority portion defined by the tapered sidewall 1323 of the main body 1304 and a minority portion defined on the second end 1308.

[0239] During use, each passageway of the plurality of irrigation passageways 1318 can receive an irrigation fluid passed through an irrigation port, through an interstitial space, and pass the irrigation fluid to an environment 1321 exterior to the distal tip 1302 (e.g., medical scope) . In the embodiment shown, each passageway of the plurality of irrigation passageways 1318 can receive an irrigation fluid passed through an irrigation port, through an interstitial space, and pass the irrigation fluid to an environment 1321 exterior to the distal tip 1302 in a plane that includes the distal end the inner elongate member and at an angle relative to the plane that includes the distalend. Stated otherwise, irrigation fluid can pass through the plurality of irrigation passageways 1318 and flow from the irrigation passageways 1318, away from the lengthwise axis 1303 of the distal tip 1302 (e.g., at an angle) and parallel to the lengthwise axis 1303, and into an environment exterior to the distal tip 1302 (e.g., medical scope). As shown in FIG. 80, each irrigation passageway 1318 is defined on both the second end 1308 and the tapered sidewall 1323. This allows for irrigation to be applied through each irrigation passageway 1318 along an axis 1313 that is parallel to the lengthwise axis 1303 of the distal tip 1302 and along an axis 1315 that is disposed at an angle relative to the lengthwise axis 1303 of the distal tip 1002. FIG. 80 illustrates a flow pathway 1320 of irrigation fluid being passed through the distal tip 1302 (e.g., outer elongate member recess 1312) and each passageway of the plurality of irrigation passageway 1318.

[0240] FIGS. 81 and 82 illustrate an alternative distal tip 1352 that can be included in a medical scope, such as those described herein. The distal tip 1352 is similar to distal tip 1002, except as described and illustrated.

[0241] In the illustrated embodiment, the distal tip 1352 has a lengthwise axis 1353 and a main body 1354. The main body 1354 has a first end 1356, a second end 1358, an outside diameter 1359, and defines an inner elongate member passageway 1360, an outer elongate member recess 1362, an imaging device passageway 1364, a light source passageway 1366, and a plurality of irrigation passageways 1368. Each of the inner elongate member passageway 1360, the imaging device passageway 1364, the light source passageway 1366, and each passageway of the plurality of irrigation passageways 1368 extends through the main body 1354 at the second end 1358 and provides access to the outer elongate member recess 1362. The opening 1361 of the inner elongate member passageway 1360 is partially defined by a sidewall 1373 of the main body 1304. The opening 1361 of the inner elongate member passageway 1360 has a majority portion defined by the sidewall 1373 and a minority portion defined on the second end 1358. Each irrigation passageway of the plurality of irrigation passageways 1368 has a central axis 1369 that is disposed at an angle relative to the lengthwise axis 1353. However, in alternative embodiments, a central axis of an irrigation passageway can be disposed at any suitable angle relative to a lengthwise axis of a distal tip. The opening 1375 of each irrigation passageway of the plurality of irrigation passageways 1368 is entirely defined by the sidewall 1373 of the main body 1304. Alternatively,an opening of an irrigation passageway can have a minority portion defined by a sidewall of a distal tip and a majority portion defined on a second end of a distal tip.

[0242] During use, each passageway of the plurality of irrigation passageways 1368 can receive an irrigation fluid passed through an irrigation port, through an interstitial space, and pass the irrigation fluid to an environment 1371 exterior to the distal tip 1352 (e.g., medical scope). Irrigation fluid can pass through the plurality of irrigation passageways 1368 and flow from the irrigation passageways 1368, away from the lengthwise axis 1353 of the distal tip 1352 (e.g., at an angle relative to the lengthwise axis 1353), and into an environment exterior to the distal tip 1352 (e.g., medical scope). In the embodiment shown, irrigation fluid flows along the central axis 1369 of an inigation passageway 1368, which is disposed at an acute angle relative to the lengthwise axis 1353 of the distal tip 1352. However, in alternative embodiments, a central axis of an irrigation passageway can be disposed at any suitable angle relative to a lengthwise axis of a distal tip, such as angles that are acute, obtuse, right, or such that a central axis is parallel to a lengthwise axis of a distal tip. FIG. 82 illustrates a flow pathway 1370 of irrigation fluid being passed through the distal tip 1352 (e.g., outer elongate member recess 1362) and each passageway of the plurality of irrigation passageway 1368.

[0243] FIGS. 83 and 84 illustrate an alternative distal tip 1402 that can be included in a medical scope, such as those described herein. The distal tip 1402 is similar to distal tip 1002, except as described and illustrated.

[0244] In the illustrated embodiment, the distal tip 1402 has a lengthwise axis 1403 and a main body 1404. The main body 1404 has a first end 1406, a second end 1408, an outside diameter 1409, and defines an inner elongate member passageway 1410, an outer elongate member recess 1412, a device passageway 1414, and a plurality of irrigation passageways 1418. Each of the inner elongate member passageway 1410, the device passageway 1414, and each passageway of the plurality of irrigation passageways 1418 extends through the main body 1404 at the second end 1408 and provides access to the outer elongate member recess 1412. Each irrigation passageway of the plurality of irrigation passageways 1418 has a central axis 1419 that is disposed parallel to the lengthwise axis 1403. However, in alternative embodiments, a central axis of an irrigation passageway can be disposed at any suitable angle relative to a lengthwise axis of a distal tip.

[0245] During use, each passageway of the plurality of irrigation passageways 1418 can receive an irrigation fluid passed through an irrigation port, through an interstitial space, and pass the irrigation fluid to an environment 1421 exterior to the distal tip 1402 (e.g., medical scope). Irrigation fluid can pass through the plurality of irrigation passageways 1418 and flow from the irrigation passageways 1418, away from the lengthwise axis 1403 of the distal tip 1402 (e.g., at an angle relative to the lengthwise axis 1403) and parallel to the lengthwise axis 1403, and into an environment exterior to the distal tip 1402 (e.g., medical scope). In the embodiment shown, irrigation fluid flows along the central axis 1419 of an irrigation passageway 1418, which is disposed parallel to the lengthwise axis 1403 of the distal tip 1402, and along an axis 1423 that is disposed at an acute angle relative to the lengthwise axis 1403 of the distal tip 1402. FIG. 84 illustrates a flow pathway 1420 of irrigation fluid being passed through the distal tip 1402 (e.g., outer elongate member recess 1412) and each passageway of the plurality of irrigation passageway 1418.

[0246] FIGS. 85 and 86 illustrate an alternative distal tip 1452 that can be included in a medical scope, such as those described herein. The distal tip 1452 is similar to distal tip 1002, except as described and illustrated.

[0247] In the illustrated embodiment, the distal tip 1452 has a lengthwise axis 1453 and a main body 1454. The main body 1454 has a first end 1456, a second end 1458, an outside diameter 1459, and defines an inner elongate member passageway 1460, an outer elongate member recess 1462, and an irrigation passageway 1468. Each of the inner elongate member passageway 1460 and the irrigation passageway 1468 extends through the main body 1454 at the second end and provides access to the outer elongate member recess 1462. The irrigation passageway 1468 has a central axis 1469 that is disposed parallel to the lengthwise axis 1453. However, in alternative embodiments, a central axis of an irrigation passageway can be disposed at any suitable angle relative to a lengthwise axis of a distal tip.

[0248] During use, the irrigation passageway 1468 can receive an irrigation fluid passed through an irrigation port, through an interstitial space, and pass the irrigation fluid to an environment 1471 exterior to the distal tip 1452 (e.g., medical scope). Irrigation fluid can pass through the irrigation passageway 1468 and flow from the irrigation passageway 1468 parallel to the lengthwise axis1453 of the distal tip 1452 and into an environment exterior to the distal tip 1452 (e.g., medical scope). FIG. 86 illustrates a portion of an inner elongate member 1470 disposed within the distal tip 1452.

[0249] FIGS. 87 and 88 illustrate an alternative distal tip 1502 that can be included in a medical scope, such as those described herein. The distal tip 1502 is similar to distal tip 1002, except as described and illustrated.

[0250] In the illustrated embodiment, the distal tip 1502 has a lengthwise axis 1503 and a main body 1504. The main body 1504 has a first end 1506, a second end 1508, an outside diameter 1509, and defines an inner elongate member passageway 1510, an outer elongate member recess 1512, and an irrigation passageway 1518. Each of the inner elongate member passageway 1510 and the irrigation passageway 1518 extends through the main body 1504 at the second end 1508 and provides access to the outer elongate member recess 1512. The irrigation passageway 1518 has a central axis 1519 that is disposed parallel to the lengthwise axis 1503. However, in alternative embodiments, a central axis of an irrigation passageway can be disposed at any suitable angle relative to a lengthwise axis of a distal tip.

[0251] During use, the irrigation passageway 1518 can receive an irrigation fluid passed through an irrigation port, through an interstitial space, and pass the irrigation fluid to an environment 1521 exterior to the distal tip 1502 (e.g., medical scope). Irrigation fluid can pass through the irrigation passageway 1518 and flow from the irrigation passageway 1518 parallel to the lengthwise axis 1503 of the distal tip 1502, and into an environment exterior to the distal tip 1402 (e.g., medical scope). FIG. 88 illustrates a portion of an inner elongate member 1520 disposed within the distal tip 1502.

[0252] FIGS. 89 through 105 illustrate a fifth example medical scope 1610 that has a first end 1612, a second end 1614, an outer elongate member 1616, an inner elongate member 1618, a handle 1620, a distal tip 1622, a first wire member 1624, and a second wire member 1626. The medical scope 1610 is moveable between a substantially straight configuration, a first deflected configuration, and a second deflected configuration, as described herein.

[0253] In the embodiment shown, the first end 1630 of the outer elongate member 1616 is partially disposed within the handle 1620 and is attached to the handle 1620. The second end 1632 is attached to the distal tip 1622. In the embodiment shown, the first end 1630 is attached to the manifold 1696 and the second end 1632 is attached to the sleeve 1782, as described in more detail herein.

[0254] The circumferential wall 1638 defines a plurality of indentations 1646 along only a distal portion 1647 of the outer elongate member 1616. similar to the indentations described herein. In the embodiment shown, the distal portion 1647 is about 8 centimeters in length. However, in alternative embodiments, a distal portion can be between about 5 centimeters and about 10 centimeters, less than 8 centimeters, or greater than 8 centimeters in length. The inner lumen 1644 extends from the first end 1630 to the second end 1632 and is in fluid communication with the manifold 1696 and the irrigation port 1698 of the handle 1620, as described in more detail herein.

[0255] The inner elongate member 1618 is disposed within, and partially extends through, the handle 1620 (e.g., the manifold 1696) and is disposed within, and partially extends through, the inner lumen 1644 of the outer elongate member 1616. The inner elongate member 1618 has a first end 1674, a second end 1676, and defines an inner elongate member lumen 1678 (e.g., working channel) that has an inside diameter 1679. The first end 1674 is attached to the handle 1620. In the embodiment shown, the first end 1674 is attached to the manifold 1696 such that the inner elongate member lumen 1678 is in fluid communication with the port 1720 of the of the manifold 1696. The second end 1676 is attached to the distal tip 1622. In the embodiment shown, the second end 1676 is attached to the chassis 1784. During use, suction can be applied to the inner elongate member lumen 1678 (e.g., concurrent with, or separate from, irrigation) to remove small stone particulate, such as particulate created during laser lithotripsy, or other treatment, and other debris while the medical scope 1610 is in the substantially straight configuration or a deflected configuration. The inside diameter 1679 of the inner elongate member 1618 is about 1.7mm. However, in alternative embodiments, an inner elongate member can have any suitable inside diameter such as those that are greater than, or less than, 1.7mm. Selection of an inside diameter of an inner elongate member can be based on various considerations, including the size of particulate desired to be removed from a bodily passage.

[0256] The interstitial space 1684 defined by the outer elongate member 1616 and the inner elongate member 1618 extends from the handle 1620 (e.g., manifold 1696) to the plurality of passageways 1800 defined by the distal tip 1622, as described in more detail herein.

[0257] In the embodiment shown, the handle 1620 is disposed on the first end 1630 of the outer elongate member 1616. The handle 1620 defines a chamber 1690, a bend 1691, and has a first end 1692, a second end 1694, a first portion 1693, a second portion 1695, a manifold 1696, an irrigation port 1698, a wire port 1702, a suction port 1701, a suction control 1705, and an actuator 1706. Other components described herein relative to other embodiments can be included in medical scope 1610, but have been omitted for clarity. The manifold 1696 is housed within the chamber 1690 defined by the handle 1620. In the illustrated embodiment, the handle 1620 is designed to be held and operated horizontally, which increases pushability of the medical scope 1610, decreases the overall length of the outer elongate member 1616, allows for single hand use, and increases comfort during use relative to devices that are operated vertically.

[0258] The first portion 1693 extends from the first end 1692, toward the second end 1694, and to the bend 1691. The second portion 1695 extends from the bend 1691, away from the first end 1692, and to the second end 1694. The first portion 1693 has a first outside width 1707 and the second portion 1695 has a second outside width 1709 that is less than the first outside width 1707. The first portion 1693 is disposed at an angle 171 1 relative to the second portion 1695 that is less than 180 degrees. In the embodiment shown, the angle 1711 is about 172 degrees. However, in alternative embodiments, an angle between first and second portions of a handle can be greater than, less than, or equal to 172 degrees.

[0259] Each of the irrigation port 1698, the suction port 1701, and the wire port 1702 is disposed on the first end 1692 of the handle 1620 and the actuator 1706 is disposed between the bend 1691 and the second end 1694. In addition, the port 1720 of the manifold 1696 is disposed between the actuator 1706 and the second end 1694. This structural arrangement provides ergonomic advantages in that it allows greater flexibility in the way the handle is held and positions various components relative to a user’s hand during use relative to current medical scopes. This structural arrangement also lowers the handle’s center of gravity, reduces fatigue due to gripping, handling,and rotating the handle, reduces slippage, and provides a straighter pathway for the suction tubing, which could decrease the probability of blockage.

[0260] The manifold 1696 is partially disposed within the chamber 1690 and between the actuator 1706 and the second end 1694 of the handle 1620. It should be noted, in some embodiments structure identified as being used for suction could be used for irrigation and structure identified as being used for irrigation could be used for suction.

[0261] The port 1720 is attached to the manifold 1696 and extends to an environment 1741 exterior to the chamber 1690 of the handle 1620. The port 1720 provides structure such that a secondary device (e.g., laser fiber) can be passed through the port 1720 and into the inner elongate member lumen 1678 while suction is concurrently applied to the inner elongate member lumen 1678.

[0262] In the embodiment shown, the irrigation port 1698 is in fluid communication with the inner lumen 1644 and interstitial space 1684. The suction port 1701 is in fluid communication with the inner elongate member lumen 1678.

[0263] The inclusion of the manifold 1696 reduces the space required relative to devices that have separate laser fiber channels and allows the medical scope 1610 to include a larger inner elongate member lumen 1678. While the manifold 1696 has been described as positioned between the actuator 1706 and the second end 1694 of the handle 1620, alternative embodiments can include a manifold, or a portion of a manifold, at other locations on a handle. For example, a manifold, or a second portion of a manifold (e.g., first and second ports), can be positioned adjacent to an actuator, between an actuator and a first end of a handle, or at a first end of a handle.

[0264] In the embodiment shown, the irrigation port 1698 of the handle 1620 is disposed on the first end 1692 of the handle 1620 and adjacent to the wire port 1702. The suction port 1701 of the handle 1620 is disposed on the first end 1692 of the handle 1620 and adjacent to the wire port 1702.

[0265] The wire port 1702 is disposed on the first end 1692 of the handle 1620 and provides access to the chamber 1690. The wire port 1702 is a conduit through which a wire harness extendsand is electrically connected to the circuit board 1708, the imaging device 1788, the pressure sensor 1790, and the light source 1792.

[0266] The suction control 1705 is disposed on the second portion 1695 of the handle 1620 and on a side opposite that of the actuator 1706. In the embodiment shown, the suction control 1705 is an actuator that is electrically, or wirelessly, connected to the circuit board 1708 such that suction can be selectively permitted and blocked by activating the suction control 1705 (e.g., pressing the button).

[0267] The distal tip 1622 is attached to the outer elongate member 1616 (e.g., second end 1632) and the inner elongate member 1618 (e.g., second end 1676). In the embodiment shown, the distal tip 1622 has a lengthwise axis 1623 and includes a sleeve 1782, a chassis 1784, an imaging device 1788, a pressure sensor 1790, and a light source 1792. The distal tip 1622 houses the components of the medical scope 1610 that enable an image of a bodily passage to be transmitted outside of the bodily passage. In the embodiment shown, the outer elongate member 1616 is attached to the sleeve 1782 between the plurality of passageways 1800 and the first end 1793 of the sleeve. The inner elongate member 1618 is attached to the chassis 1784.

[0268] The sleeve 1782 is disposed between the outer elongate member 1616 and the chassis 1784. As shown primarily in FIGS. 105 and 106, the sleeve 1782 has a first end 1793, a second end 1795, and a main body 1796 that defines a central passageway 1798, a plurality of passageways 1800 that are in fluid communication with the interstitial space 1684, and a notch 1802. The central passageway 1798 receives the inner elongate member 1618 and the second wire harness 1776. Each passageway of the plurality of passageways 1800 extends through the main body 1796 and provides access between the interstitial space 1684 and an environment 1685 exterior to the interstitial space 1684. Each passageway of the plurality of passageways 1800 is in fluid communication with the interstitial space 1684 defined between the outer elongate member 1616 and the inner elongate member 1618 and acts as an outlet for irrigation fluid during use.

[0269] For example, during use, irrigation fluid travels from a source connected to the handle 1620 (e.g., irrigation port 1698), through the manifold 1696, through the interstitial space 1684, through some, or each, of the plurality of passageways 1800, and into a bodily passage (e.g., renal cavity). In the embodiment shown, the plurality of passageways 1800 comprise seven passagewaysand are irrigation passageways. Irrigation fluid can pass through the plurality of irrigation passageways 1800 and flow from the irrigation passageways 1800, away from the lengthwise axis 1629 of the outer elongate member 1616 and the lengthwise axis 1623 of the distal tip 1622, and into an environment exterior to the distal tip 1622 (e.g., medical scope). In the embodiment shown, fluid can pass through the plurality of irrigation passageways 1800 and flow from the irrigation passageways 1800, laterally, or orthogonally, relative to the lengthwise axis 1629 of the outer elongate member 1616 and the lengthwise axis 1623 of the distal tip 1622, and into an environment exterior to the distal tip 1622 (e.g., medical scope). Four passageways 1801 of the plurality of passageways 1800 are disposed on a plane 1803 disposed orthogonal to the lengthwise axis 1629 of the outer elongate member 1616 and the lengthwise axis 1623 of distal tip 1622 and have a first, circular cross-sectional, configuration. Two passageways 1805 of the plurality of passageways 1800 extend around a portion of the circumference of the sleeve 1782 and have a second, elongated, configuration that is different than the first configuration. A seventh passageway 1807 is disposed between the four passageways 1801 and the second end 1794 and provides access for the pressure sensor 1790. However, alternative embodiments may include a passageway, or a plurality of passageways, that are configured in any suitable pattern on a sleeve. The notch 1802 extends from the second end 1795 and toward the first end 1793 receives a portion of the chassis 1784.

[0270] As shown primarily in FIGS. 105 and 106, the chassis 1784 has a first end 1806, a second end 1808, and a main body 1810 that defines an imaging device / light source recess 1812, a pressure sensor recess 1814, a central channel 1816, an angled portion 1817, a projection 1819, and houses the imaging device 1788, the pressure sensor 1790, and the light source 1792. The imaging device / light source recess 1812 extends to the second end 1614 of the medical scope 1610 and the pressure sensor recess 1814 extends to a side of the chassis 1784. The angled portion 1817 extends from the second end 1808 towards the first end 1806 and aids in the removal of stone fragments and dust created during lithotripsy. The second end 1808 and angled portion 1817 have rounded edges to avoid trauma to tissue surrounding a bodily passageway. The projection 1819 extends from the first end 1806 toward the second end 1808 and mates with the notch 1802 to prevent rotation of the chassis 1784 relative to the sleeve 1782 during use.

[0271] The second end 1822 of the first wire member 1624 is disposed between the outer elongate member 1616 and the distal tip 1622. In the embodiment shown, the second end 1822 ofthe first wire member 1624 has a ferrule 1824 that is disposed between the outer elongate member 1616 and the chassis 1784. The second end 1828 of the second wire member 1626 is disposed between the outer elongate member 1616 and the distal tip 1622. In the embodiment shown, the second end 1828 of the second wire member 1626 has a ferrule 1830 that is disposed between the outer elongate member 1616 and the chassis 1784.

[0272] During use, the medical scope 1610 is advanced into a bodily passage and the handle 1620 is held by a user to control the functionality of the various components. A treatment device (e.g., laser fiber) is passed through the port 1720 of the manifold 1696, through the inner elongate member lumen 1678, and to the second end 1614 of the medical scope 1610 such that treatment can be performed. In addition, suction can be applied to the suction port 1701, such that suction is applied through the inner elongate member lumen 1678 and at the second end 1614 of the medical scope 1610. Moreover, irrigation can be applied to the irrigation port 1698 such that irrigation fluid travels through the manifold 1696, through the interstitial space 1684, and to the second end 1614 of the medical scope 1610. Optionally, treatment using the treatment device, suction, and / or irrigation can all be accomplished concurrently, or separately. Use of a leak-proof seal (e.g., Touhy Borst adapter) when passing a laser fiber through the port 1720 reduces or prevents a loss of suction within the inner elongate member lumen 1678 during use.

[0273] It will be apparent from the foregoing disclosure that a variety of refinements of the devices and / or features described in the claims are envisioned, for example a medical scope as described herein comprises an outer elongate member having a lengthwise axis, a first end, a second end, and a circumferential wall extending between the first end and the second end, the circumferential wall defining an inner lumen and an indentation; an inner elongate member extending within the inner lumen, the inner elongate member having a central axis, a first axial portion, a second axial portion disposed circumferentially adjacent to the indentation, and defining an inner elongate member lumen, the central axis along the first axial portion disposed on a first axis, the central axis along the second axial portion disposed on a second axis that is different than the first axis; a distal tip attached to the outer elongate member and the inner elongate member; a handle disposed on the first end of the outer elongate member, the handle including an actuator; and a wire member attached to the actuator, the wire member extending partially through the inner lumen and radially outward of the indentation.

[0274] In such a medical scope, such as any one of the medical scopes claimed herein, the outer wall may comprise an inner surface and an outer surface. The indentation may provide a channel, such as the channel 52, on the outer surface of the outer elongate member. The channel may be parallel with the lengthwise axis and configured to maintain the position of and guide movement of the wire member. It will therefore be appreciated that the wire member extending partially through the inner lumen and radially outward of the indentation may be provided by a first portion of the wire member extending through the inner lumen and a second portion of the wire member extending radially outward of the indentation. For example, the second portion of the wire member may extend along a channel defined by the indentation on the outer surface of the outer elongate member. The first portion of the wire member may be disposed between the outer elongate member and the inner elongate member. The indentation defined by the wall of the outer elongate member may cause the inner surface of the wall to extend radially inward towards the inner elongate member.

[0275] The above embodiments are to be understood as illustrative examples. Those with ordinary skill in the art will appreciate that various modifications and alternatives for the described and illustrated embodiments can be developed in light of the overall teachings of the disclosure, and that the various elements and features of one example described and illustrated herein can be combined with various elements and features of another example without departing from the scope of the invention. For example, it is to be understood that any feature described in relation to any one embodiment may be used alone, or in combination with other features described, and may also be used in combination with one or more features of any other of the embodiments, or any combination of any other of the embodiments. In a specific example, it is to be understood that any feature described in relation to any one embodiment of a handle, outer elongate member, inner elongate member, and / or distal tip may be used alone, or in combination with other features described relative to any other handle, outer elongate member, inner elongate member, and / or distal tip, and may also be used in combination with any handle, outer elongate member, inner elongate member, and / or distal tip described herein. Accordingly, the particular arrangement of elements and steps disclosed herein have been selected by the inventor(s) simply to describe and illustrate examples of the invention and are not intended to limit the scope of the invention or its protection, which is to be given the full breadth of the appended claims and any and all equivalents thereof.

Claims

What is claimed is:

1. A medical scope comprising: an outer elongate member having a lengthwise axis, a first end, a second end, and a circumferential wall extending between the first end and the second end, the circumferential wall defining an inner lumen and an indentation; an inner elongate member extending within the inner lumen, the inner elongate member having a central axis, a first axial portion, a second axial portion disposed circumferentially adjacent to the indentation, and defining an inner elongate member lumen, the central axis along the first axial portion disposed on a first axis, the central axis along the second axial portion disposed on a second axis that is different than the first axis; a distal tip attached to the outer elongate member and the inner elongate member; a handle disposed on the first end of the outer elongate member, the handle including an actuator; and a wire member attached to the actuator, the wire member extending partially through the inner lumen and radially outward of the indentation.

2. The medical scope of claim 1, wherein the central axis along the first axial portion is disposed a first distance from the lengthwise axis of the outer elongate member; wherein the central axis along the second axial portion is disposed a second distance from the lengthwise axis of the outer elongate member; and wherein the first distance is less than the second distance.

3. The medical scope of claim 1, wherein the wire member is disposed between the outer elongate member and the inner elongate member.

4. The medical scope of claim 1 , wherein the outer elongate member comprises a tubular shaft and a jacket disposed over the tubular shaft.

5. The medical scope of claim 4, wherein the tubular shaft has a circumferential wall and defines a plurality of slits extending through the circumferential wall of the tubular shaft.

6. The medical scope of claim 5, wherein the jacket covers each slit in the plurality of slits.

7. The medical scope of claim 6, wherein a first slit of the plurality of slits is axially adjacent to a second slit of the plurality of slits; wherein the outer elongate member has a first side and a second side opposably facing the first side relative to the lengthwise axis of the outer elongate member; and wherein the first slit is disposed on the first side and the second slit is disposed on the second side.

8. The medical scope of claim 6, wherein the plurality of slits comprises a plurality of single slits and sets of axially adjacent double slits, each single slit of the plurality of single slits having a first circumferential length, each slit within a set of axially adjacent double slits having a second circumferential length that is less than the first circumferential length; and wherein each set of double slits is disposed between two single slits and circumferentially adjacent to a single slit.

9. The medical scope of claim 1 , wherein the outer elongate member has a first side and a second side, the first side opposably facing the second side relative to the lengthwise axis of the outer elongate member; wherein the indentation comprises a first indentation and a second indentation; wherein the first indentation is positioned on the first side of the outer elongate member and the second indentation is positioned on the second side of the outer elongate member; and wherein the wire member is disposed radially outward of the first indentation.

10. The medical scope of claim 9, wherein the first indentation is disposed on a first axis that is disposed orthogonally to the lengthwise axis of the outer elongate member; and wherein the second indentation is disposed on a second axis that is disposed orthogonally to the lengthwise axis of the outer elongate member that is different than the first axis.

11. The medical scope of claim 10, wherein the wire member comprises a first wire member and a second wire member; and wherein the second wire is disposed radially outward of the second indentation.

12. The medical scope of claim 1, further comprising an imaging device, a temperature sensor, a pressure sensor, and a light source disposed on the distal tip.

13. The medical scope of claim 1, wherein the handle has a manifold, the manifold having a first port and a second port in fluid communication with the inner elongate member lumen.

14. The medical scope of claim 1 , wherein the outer elongate member and the inner elongate member cooperatively define an interstitial space between the outer elongate member and the inner elongate member; and wherein the handle has an irrigation port in fluid communication with the interstitial space.

15. The medical scope of claim 1 , further comprising a suction control disposed on the handle, the suction control having a main body and an actuator, the actuator of the suction control configured to selectively permit and block suction through the inner elongate member.

16. The medical scope of claim 15, wherein the main body of the suction control defines a central passageway in fluid communication with the inner elongate member lumen.

17. The medical scope of claim 1, wherein the outer elongate member and the inner elongate member cooperatively define an interstitial space between the outer elongate member and the inner elongate member; and wherein the outer elongate member and the distal tip cooperatively define an opening in fluid communication with the interstitial space.

18. The medical scope of claim 1, wherein the outer elongate member has a first portion, a second portion, a third portion, and a fourth portion, the first portion extending from the first end of the outer elongate member to the second portion, the second portion extending from the first portion to the third portion, the third portion extending from the second portion to the fourth portion, the fourth portion extending from the third portion to the second end of the outer elongate member, the first portion having a first stiffness, the second portion having a second stiffness that is different than the first stiffness, the third portion having a third stiffness that is different than thesecond stiffness, and the fourth portion having a fourth stiffness that is different than the third stiffness.

19. The medical scope of claim 1, wherein the circumferential wall comprises an inner surface an outer surface; and wherein the indentation defines a channel in the outer surface that is parallel with the lengthwise axis.

20. The medical scope of claim 19. wherein the channel is configured to maintain a position of the wire member and guide movement of the wire member.

21. The medical scope of claim 19, wherein the inner surface of the circumferential wall extends radially inward towards the inner elongate member.

22. A medical scope comprising: an outer elongate member having a lengthwise axis, a first end, a second end, and a circumferential wall extending between the first end and the second end, the circumferential wall defining an inner lumen and an indentation; an inner elongate member extending within the inner lumen and cooperatively defining an interstitial space with the outer elongate member, the inner elongate member having a central axis, a first axial portion, a second axial portion disposed circumferentially adjacent to the indentation, and defining an inner elongate member lumen, the central axis along the first axial portion disposed on a first axis and a first distance from the lengthwise axis of the outer elongate member, the central axis along the second axial portion disposed on a second axis and a second distance from thelengthwise axis of the outer elongate member, the second axis being different than the first axis, the first distance being less than the second distance; a distal tip attached to the outer elongate member and the inner elongate member; a handle disposed on the first end of the outer elongate member, the handle including an actuator, a manifold, and an irrigation port, the manifold having a first port and a second port in fluid communication with the inner elongate member lumen, the irrigation port in fluid communication with the interstitial space; and a wire member attached to the actuator and the distal tip. the wire member extending partially through the inner lumen between the outer elongate member and the inner elongate member and radially outward of the indentation.

23. A medical scope comprising: an outer elongate member having a lengthwise axis, a first end, a second end, a first side, a second side opposably facing the first side relative to the lengthwise axis, and a circumferential wall extending between the first end and the second end, the circumferential wall defining an inner lumen, a first indentation, and a second indentation, the first indentation positioned on the first side of the outer elongate member and disposed on a first axis, the second indentation positioned on the second side of the outer elongate member and disposed on a second axis, the first axis disposed orthogonally to the lengthwise axis, the second axis disposed orthogonally to the lengthwise axis and different than the first axis; an inner elongate member extending within the inner lumen and cooperatively defining an interstitial space with the outer elongate member, the inner elongate member having a central axis, a first axial portion, a second axial portion disposed circumferentially adjacent to the first indentation, and defining an inner elongate member lumen, the central axis along the first axial portion disposed on a third axis and a first distance from the lengthwise axis of the outer elongate member, the central axis along the second axial portion disposed on a fourth axis and a seconddistance from the lengthwise axis of the outer elongate member, the fourth axis being different than the third axis, the first distance being less than the second distance; a distal tip attached to the outer elongate member and the inner elongate member; a handle disposed on the first end of the outer elongate member, the handle including an actuator, a manifold, and an irrigation port, the manifold having a first port and a second port in fluid communication with the inner elongate member lumen, the irrigation port in fluid communication with the interstitial space; a first wire member attached to the actuator and the distal tip, the first wire member extending partially through the inner lumen between the outer elongate member and the inner elongate member and radially outward of the first indentation; and a second wire member attached to the actuator and the distal tip, the second wire member extending partially through the inner lumen between the outer elongate member and the inner elongate member and radially outward of the second indentation.

24. A medical scope comprising: a handle having an actuator; an outer elongate member having a first end partially disposed within the handle, a second end, and an inner lumen having an inner lumen inside diameter; an inner elongate member extending within the inner lumen and partially disposed within the handle, the inner elongate member defining an inner elongate member lumen having an inner elongate member lumen inside diameter, the inner elongate member and the outer elongate member cooperatively defining an interstitial space between the inner elongate member and the outer elongate member, the inner elongate member lumen inside diameter greater than % of the inner lumen inside diameter;a distal tip attached to the outer elongate member and the inner elongate member, the distal tip defining a passageway in fluid communication with the interstitial space; and a wire member attached to the actuator, the wire member extending partially through the inner lumen.

25. The medical scope of claim 24, the inner elongate member lumen having a first cross- sectional area taken along a cross-section of said medical scope between the first end and the second end. the interstitial space having a second cross-sectional area taken along the cross-section, the first cross-sectional area being greater than the second cross-sectional area.

26. The medical scope of claim 24, wherein the distal tip and the outer elongate member cooperatively define the passageway in fluid communication with the interstitial space.

27. A medical scope comprising: a handle having an actuator; an outer elongate member having a first end partially disposed within the handle, a second end, and an inner lumen; an inner elongate member extending within the inner lumen and partially disposed within the handle, the inner elongate member defining an inner elongate member lumen, the inner elongate member and the outer elongate member cooperatively defining an interstitial space between the inner elongate member and the outer elongate member; a distal tip attached to the outer elongate member and the inner elongate member, the distal tip defining a passageway in fluid communication with the interstitial space that directs a fluid passed through the interstitial space from the distal tip; anda wire member attached to the actuator, the wire member extending partially through the inner lumen; wherein suction applied to the inner elongate member lumen directs the fluid passed from the distal tip into the inner elongate member lumen and towards the handle.

28. The medical scope of claim 27, wherein the inner lumen has an inner lumen inside diameter; and wherein the inner elongate member lumen has an inner elongate member lumen inside diameter, the inner elongate member lumen inside diameter greater than Vi of the inner lumen inside diameter.

29. The medical scope of claim 27, the inner elongate member lumen having a first cross- sectional area taken along a cross-section of said medical scope between the first end and the second end, the interstitial space having a second cross-sectional area taken along the cross-section, the first cross-sectional area being greater than the second cross-sectional area.

30. The medical scope of claim 27, wherein the distal tip and the outer elongate member cooperatively define the passageway in fluid communication with the interstitial space.

31. The medical scope of claim 27, wherein the outer elongate member has a lengthwise axis; and wherein the passageway directs the fluid passed through the interstitial space from the distal tip orthogonally relative to the lengthwise axis of the outer elongate member.

32. The medical scope of claim 27, wherein the distal tip has a lengthwise axis; and wherein the passageway directs the fluid passed through the interstitial space from the distal tip parallel to the lengthwise axis of the distal tip.

33. The medical scope of claim 27. wherein the distal tip has a lengthwise axis; and wherein the passageway directs the fluid passed through the interstitial space from the distal tip at an acute angle relative to the lengthwise axis of the distal tip and parallel to the lengthwise axis of the distal tip.

Images